To retrospectively analyze the clinical data of patients with ESRD undergoing cardiac death organ donation free (DCD) renal transplant, summarize the recovery condition after renal transplantation and the influence of DCD donor to recipient and graft postoperative.
There were 32 donors in 63 cases of DCD renal transplantation, including 28 men and four women. Their ages ranged from 3-62 years old, and the average age was 33.5 years. The donors included 28 cases of traumatic brain injury, two cases of cerebral tumor, one case of cerebral vascular accident, five children donors, 16 with preoperative abnormal creatinine (sCr).The 63 recipients included 43 men and 20 women. Their ages ranged from 25-49 years old. The average age was 33.5 years. Recipients were 23 cases of chronic glomerulonephritis original disease, 18 cases of chronic renal insufficiency, and the nine cases of high blood pressure, six cases of nephrotic syndrome, seven other cases. The recipient’s blood type were 13 type A, 30 type B, 20 type O. HLA antigen matching included four cases of five antigen mismatches, 18 cases of four antigen mismatches, 31 cases of three antigen mismatches, two antigen mismatches 11 cases. Minimized or avoided the use of strong contraction of norepinephrine renal artery vasoactive drugs during donor maintenance. Indicators for kidney assessment: clinical data including age, blood pressure, heart rate, urine output, creatinine, primary disease, past history kidney disease, dying time, vasoactive drug use, B-renal morphology and blood flow in B-ultrasound; the warm ischemia time and cold ischemic time of donor renal; color, shape and texture of donor renal; the kidney quality by application life-port renal perfusion assessment instrument; donor kidney biopsy. ARI DCD donor kidney transplant acceptance criteria: no history of chronic kidney disease, negative biopsy, no chronic structural lesions (alternative), age <50 years, occurred during or after the trauma ICU to maintain, obvious inducement, abdominal ultrasound examination without morphological abnormalities, vascular tree clear, common causes: prehospital hypovolemic shock, boosting drugs during ICU, traumatic brain injury lead to lower blood pressure perfusion, rhabdomyolysis myoglobin casts. Caution or waive the standard for kidney: die because of drowning, suffocation longer time; active infection without treatment; ICU treatment time for more than one week; dying more than 1 hour, warm ischemia time over 30 min; appearance “gray”, and after heparin infusion cannot be restored; life-port continuous perfusion RI >0.6, continuous infusion flow rate <50 mL/min; renal transplant biopsy shows a wide range of micro-thrombosis. The adoption of immunosuppressive regimen was ATG + TAC + MMF + Pre.
Forty-seven cases donors had normal sCr, 19 cases had delayed graft function (DGF) after transplantation, accounting for 40.4%. Ten cases dialyzed postoperative, accounting for 21.3%, who had an average of dialysis three times. The sCr recovery the normal time was 10.7 days. There were 16 donors had abnormal sCr (sCr at 184-504 umol/between L). All had DGF postoperative, accounting for 100%. And 11 cases dialyzed postoperative, accounting for 68.7%, an average of 6.7 times. The time of sCr returned to normal was 28.9 days after surgery. There were a total of 63 cases of DCD renal transplantation, including 35 cases of DGF, accounted for 55.6%. And 21 cases, accounting for 33.3%, should do hemodialysis postoperative. Seven cases suffered from acute rejection, 11 cases had different degree of the infection in different parts, one case died, and three cases had renal allograft loss.
Of the 63 cases of DCD renal transplantation in our hospital, through the follow up of 312 months, 94.7% of recipients transplanted kidney maintain good function in the short term. Living donor restrictions, death row organs have been banned, DCD is now an important part of the organ sources in China. Facing the organ shortage, DCD is a very potential solution of organ transplantation.