イワドウ カズヒロ   IWADOH Kazuhiro
  岩藤 和広
   所属   医学部 医学科(東京女子医科大学病院)
   職種   非常勤講師
論文種別 原著
言語種別 英語
査読の有無 査読あり
表題 Outcomes of Kidney Transplantation from Circulatory Death Donors With Increased Terminal Creatinine Levels in Serum
掲載誌名 正式名:Transplantation
略  称:Transplantation
ISSNコード:00411337
掲載区分国外
出版社 Wolters Kluwers Health, Inc.
巻・号・頁 100(7),pp.1532-1540
著者・共著者 Tomita Yusuke†*, Tojimbara Tamotsu, Iwadoh Kazuhiro, Nakajima Ichiro, Fuchinoue Shohei
発行年月 2016/07
概要 BACKGROUND: To alleviate chronic renal graft shortages in Japan, donation after circulatory death (DCD) is an increasingly used organ resource. Organs from DCD donors with progressively increased terminal creatinine (t-Cr) levels are frequently used, but the effects of this condition on kidney transplantation (KTx) remain unclear. METHODS: Between 1996 and 2013, 99 KTx from DCD donors were conducted in our department. Recipients were grouped according to the t-Cr (in mg/dL) of donors: group 1, t-Cr less than < 1.5; group 2, 1.5 </= t-Cr < 3.0; and group 3, t-Cr >/= 3.0. We analyzed the long-term outcomes of KTx from DCD donors retrospectively in terms of donors' terminal renal function. RESULTS: The respective mean donor t-Cr in groups 1, 2, and 3 were 0.73 +/- 0.28, 2.02 +/- 0.40, and 6.69 +/- 3.68. The respective death-censored graft survival rates (%) in groups 1, 2, and 3 were 90.2, 96.2, and 86.7 at 1 year and 70.3, 86.2, and 73.4 at 10 years after transplantation. Group 1 exhibited lower incidence of delayed graft function than either group 2 or group 3 (80.5% vs 100% and 93.3%). Nevertheless, no significant difference was found between groups for several measures: Cr levels 1 month after KTx and lowest Cr levels throughout the observation period, prevalence of biopsy-proven acute rejection, and graft survival. Cox proportional hazard regression showed that donor age, cerebrovascular event, terminal urine output, and history of hypertension were significantly associated with graft survival. CONCLUSIONS: Results suggest that, under certain conditions, kidneys from DCD donors with progressively increased t-Cr can be used safely with promising long-term outcomes.
DOI 10.1097/TP.0000000000000955