小肾块是否可以用于移植?面对伊比利亚美洲移植肾移植短缺的新策略

D. Castañeda-Millán, H. García-Perdomo, A. Alcaraz
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引用次数: 0

摘要

肾移植(KTx)是终末期肾病(ESRD)患者的最佳治疗选择1;然而,在世界范围内获得KTx有很多障碍。主要的障碍之一是来自尸体供体的肾脏移植的稀缺此外,在许多拉丁美洲国家,器官捐赠率(来自脑死亡捐赠者)在过去十年中趋于稳定,不能满足ktx的社会需求具体来说,在哥伦比亚,尽管最近有一些立法举措(实施选择性退出器官捐赠制度),但器官捐赠率并没有增长,而且仍然没有关于心脏死亡后捐赠的协议和法规。据估计,目前有3000多人在等候ktx肾移植缺乏是一个全球性的问题。目前,有许多方法可以减轻其对KTx等待名单人口的影响:促进肾脏活体供体计划(包括配对肾脏捐赠),实施心脏死亡后捐赠协议,增加扩大标准供体的使用以及一些所谓的边缘条件(急性肾损伤,老年供体和小肾块[SRMs])的肾脏移植。基于极低的局部、对侧复发和转移率,后者已被证明是离体肿瘤切除后KTx的安全选择。西班牙最近的经验表明,这些肾移植对于老年患者(60岁以下)或有明显合并症的患者是可以接受的。本研究共移植了13例伴有SRM(平均肿瘤大小<2 cm)的同种异体肾移植。所有移植肾均在手术期间切除肿瘤,并立即进行病理分析以评估阴性手术切缘。最常见的肿瘤类型是透明肾细胞癌(RCC),所有肿瘤的组织学分级均较低(Furhman I和II)。所有KTx受体均无局部肿瘤复发或转移,8年随访时移植物存活率为70%。最近,Cristea等人7描述并总结了世界上最可靠的经验:到2020年,共有147个srm肾脏被移植(81%的rcc)。只有2例复发(1.4%),1年随访时移植物存活率为95%。术后并发症包括尿漏(4.5%)、出血及再手术(1.8%)、动静脉瘘或假性动脉瘤(1.8%)。类似地,Hevia等人8在5年随访中描述了95.6%的总移植物存活率和100%的无复发存活率。肿瘤平均大小为2cm。在中国和澳大利亚的人群中也有类似的经历:移植肾移植物与SRMs,显示出相似的总体和移植物存活率和并发症;局部复发率也很低
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Is it Possible to Use Kidneys with Small Renal Masses for Transplant? A New Strategy to Face Kidney Graft Shortage for Transplantation in Ibero-America
Kidney transplantation (KTx) is the best treatment alternative for patients with end-stage renal disease (ESRD)1; however, there are many barriers to obtaining a KTx worldwide. One of themain barriers is the scarcity of kidney grafts from cadaveric donors.2 Furthermore, in many Latin American countries, organ donation rates (from brain death donors) have stabilized during the last decade and do not meet the social needs for KTx.3 Specifically, in Colombia, organ donation rates have not grown despite some recent legislative initiatives (implementation of opt-out organ donation system)4 and there are still no protocols and regulations for donation after cardiac death. Currently, it is estimated that approximately 3000 people on the waiting list for KTx.5 The scarcity of kidney grafts for transplantation is a global issue. Currently, there are many ways to mitigate its impact on the KTx waiting list population: promoting kidney living donors programs (including paired kidney donation), implementing protocols for donation after cardiac death, and increasing the use of expanded criteria donors and kidney grafts with some, so called, marginal conditions (acute kidney injury, elderly donors and small renal masses [SRMs]). The latter has proven to be a safe option for KTx after ex-vivo bench tumor excision based on the very low local, contralateral recurrence and metastatic rates. The most recent Spanish experience6 showed that these kidney grafts are acceptable for elderly patients (> 60 years) or patients with significant comorbidities. In this study, 13 kidney allografts with SRM (mean tumor size<2 cm) were transplanted. All kidney grafts underwent tumor excision during bench surgery with immediate pathologic analysis to assess negative surgical margins. Themost common tumoral typewas clear renal cell carcinoma (RCC), and all tumors had low histological grade (Furhman I and II). All KTx recipients remained free of local tumor recurrence or metastasis, having a 70% graft survival at an eight-year follow-up. Recently, Cristea et al.7 described and summarized the most robust world experience: a total of 147 kidneys with SRMs were transplanted until 2020 (81% RCCs). There were only two recurrences (1.4%) with a graft survival at one-year follow-up of 95%. The postoperative complications included urine leakage (4.5%), bleeding and re-operation (1.8%), and arteriovenous fistulae or pseudoaneurysm (1.8%). Similarly, Hevia et al.8 described a 95.6% overall graft survival rate and a 100% recurrence-free survival rate at a five-year follow-up. The mean tumor size was 2 cm. There are also similar experiences in Chinese and Australian groups: transplanted kidney grafts with SRMs, showing similar overall and graft survival and complications; and a very low local recurrence rate.9,10
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来源期刊
Urologia Colombiana
Urologia Colombiana Medicine-Urology
CiteScore
0.30
自引率
0.00%
发文量
26
期刊介绍: Urología Colombiana is the serial scientific publication of the Colombian Society of Urology at intervals of three issues per year, in which the results of original research, review articles and other research designs that contribute to increase knowledge in medicine and particularly in the specialty of urology.
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