본 논문은 42차 대한이식학회에서 구연 발표되었으며, 2011년도 대한 이식학회 한국아스텔라스 젊은 연구자 연구비 지원으로 이루어졌음.
This study was conducted in order to evaluate the propriety of expanded donor criteria in Korea and to identify the preoperative factors influencing allograft survival and function.
We studied 404 patients who received deceased renal transplants from five transplantation centers of 2, 3 territory from 2000 to 2010. Differences in 1-year graft function, delayed graft function (DGF) rate, and graft survival rate between the standard criteria donor (SCD) and expanded criteria donor (ECD) were compared retrospectively. The preoperative factors influencing graft function and graft survival were analysed.
SCD showed significantly better 1-year graft function than ECD (
Graft function, DGF rates of ECD were poorer than those of SCD. Graft survival rate of ECD was comparable to that of SCD kidney. Korean Network for Organ Sharing expanded criteria may underestimate the organ quality of deceased kidney and modification may be needed in order to expand the potential donor pool through nationwide study.
Renal allograft survival rate according to donor criteria: standard criteria donor (SCD) versus expanded criteria donor (ECD).
Influence of donor age on recipient allograft survival.
Total of 71 patients were assorted as expanded criteria donor (ECD) by Korean Network for Organ Sharing (KONOS) criteria and only 27 patients (38.0%) of them were expanded donor by United Network for Organ Sharing (UNOS) criteria. Abbreviation: SCD, standard criteria donor.
Kidney grade determined by Nyberg donor score in 71 patients of Korean Network for Organ Sharing expanded criteria donor.
Comparison of recipient and donor characteristics
Variable | SCD (n=333) | ECD (n=71) | |
---|---|---|---|
Recipient characteristics | |||
Age | 42.5±10.6 | 44.7±12.0 | 0.111 |
Male | 180 (54.1) | 41 (57.7) | 0.601 |
Duration of dialysis | 67.6±41.8 | 62.6±52.5 | 0.080 |
Body mass index (kg/m2) | 22.1±3.3 | 22.6±3.4 | 0.231 |
Cause of ESRD | 0.304 | ||
Diabetes mellitus | 27 (8.1) | 5 (7.0) | |
Hypertension | 82 (24.6) | 20 (28.2) | |
Glomerulonephritis | 173 (52.0) | 41 (57.7) | |
Others | 51 (15.3) | 5 (7.0) | |
Previous transplant | 50 (15.0) | 10 (14.1) | 0.858 |
HLA zero mismatch | 21 (6.3) | 7 (9.9) | 0.303 |
No. of HLA mismatches | 3.7±1.5 | 3.9±1.7 | 0.001 |
Donor characteristics | |||
Age | 38.2±13.8 | 44.8±16.6 | <0.001 |
Male | 226 (67.9) | 54 (76.1) | 0.203 |
History of hypertension | 49 (14.7) | 19 (26.8) | 0.016 |
Diabetes mellitus | 6 (1.8) | 4 (5.6) | 0.080 |
Cause of death | 0.703 | ||
Cerebrovascular accident | 289 (86.8) | 60 (84.5) | |
Others | 44 (13.2) | 11 (15.5) | |
Body mass index (kg/m2) | 22.2±2.9 | 22.8±3.1 | 0.085 |
Proteinuria (≥++, 2 times) | 0 (0) | 11 (15.5) | 0.000 |
Use of norepinephrine | 155 (46.5) | 38 (53.5) | 0.298 |
Data are presented as mean±SD or number (%).
Abbreviations: SCD, standard criteria donor; ECD, extended criteria donor; ESRD, end stage renal disease; HLA, human leukocyte antigen.
Causes which assorted deceased donor as expanded criteria donor
Variable | ECD (n=71) |
---|---|
Nonheart beating donor | 3 (4.2) |
Hypotensive attack |
17 (23.9) |
Age ≥60 years | 16 (22.5) |
sCr ≥3.0 mg/dL or CrCl ≤60 mL/min | 24 (33.8) |
Proteinuria (≥++) ≥2 times | 8 (11.3) |
Proteinuria (≥++) ≥2 times+sCr ≥3.0 mg/dL | 2 (2.8) |
Age ≥60 years+sCr ≥3.0 mg/dL | 1 (1.4) |
Abbreviation: ECD, extended criteria donor.
Cardiac arrest during donor management.
Comparison of clinical results in terms of estimated glomerular filtration rate, acute resection episode, and delayed graft function between standard criteria donor and expanded criteria donor
Variable | SCD (n=333) | ECD (n=71) | |
---|---|---|---|
eGFR at 6 mo | 66.5±29.1 | 57.3±17.1 | 0.007 |
eGFR at 1 yr | 66.1±27.9 | 57.3±20.2 | 0.011 |
eGFR at 3 yr | 64.2±27.4 | 60.0±29.4 | 0.202 |
eGFR at 5 yr | 61.8±30.3 | 63.7±37.4 | 0.806 |
Acute rejection within 1 yr | 44 (13.2) | 12 (16.9) | 0.449 |
Delayed graft function | 47 (14.1) | 18 (25.4) | 0.022 |
Data are presented as mean±SD or number (%).
Abbreviation: eGFR, estimated glomerular filtration rate calculated by Modification of Diet in Renal Disease equation.
Donor variables associated with recipient estimated glomerular filtration rate at 1 year
Donor variables | No. (%) | eGFR at 1 year (mL/min/1.73 m2) | |
---|---|---|---|
Age (yr) | <0.001 | ||
<20 | 56 (13.9) | 79.9±27.3 | |
20∼39 | 110 (27.2) | 65.2±29.7 | |
40∼59 | 221 (54.7) | 61.5±23.8 | |
≥60 | 17 (4.2) | 49.8±26.9 | |
Creatinine (mg/dL) | 0.030 | ||
<1.5 | 262 (64.9) | 66.7±27.2 | |
1.5∼2.9 | 113 (28.0) | 60.6±27.4 | |
≥3.0 | 29 (7.2) | 59.9±18.7 | |
Proteinuria (≥2++) | 0.894 | ||
Present | 11 (2.7) | 63.7±16.1 | |
Absent | 393 (97.3) | 64.5±27.1 | |
Cardiac arrest event during donor management | 0.266 | ||
Yes | 20 (5.0) | 59.5±19.5 | |
No | 384 (95.0) | 64.8±27.2 | |
Hypertension history | 0.047 | ||
Yes | 68 (6.8) | 59.9±26.0 | |
No | 336 (83.2) | 65.5±27.0 | |
Cause of death | 0.004 | ||
CVA | 349 (86.4) | 63.5±27.7 | |
Non-CVA | 55 (13.6) | 70.9±20.3 | |
HLA mismatch | 0.632 | ||
0 | 28 (6.9) | 63.4±23.2 | |
1 | 9 (2.2) | 51.8±16.0 | |
2 | 29 (7.2) | 62.6±21.6 | |
3 | 76 (18.8) | 67.7±26.6 | |
4 | 122 (30.2) | 64.2±26.1 | |
5 | 109 (27.0) | 64.7±31.3 | |
6 | 31 (7.7) | 63.8±24.6 |
Data are presented as mean±SD.
Abbreviations: eGFR, estimated glomerular filtration rate; CVA, cerebrovascular accident; HLA, human leukocyte antigen.
Multivariate regression models for risk factors of 1-year estimated glomerular filtration rate after deceased donor kidney transplantation
Risk factor | B | SE | β | T | |
---|---|---|---|---|---|
Donor age | |||||
20∼39 | −13.084 | 4.428 | −0.217 | −3.003 | 0.003 |
40∼59 | −16.607 | 4.081 | −0.308 | −4.069 | <0.001 |
≥60 | −28.230 | 7.597 | −0.211 | −3.716 | <0.001 |
Serum creatinine (mg/dL) | |||||
1.5∼2.9 | −4.548 | 2.978 | −0.076 | −1.527 | 0.127 |
≥3.0 | −5.699 | 5.178 | −0.055 | −1.100 | 0.272 |
History of hypertension | −1.253 | 3.664 | −0.017 | −0.342 | 0.733 |
Cause of death (CVA) | −1.253 | 3.920 | −0.032 | −0.649 | 0.517 |
Adjust
Abbreviations: B, unstandardised beta coefficient; SE, standard error; β, standardised beta coefficient; T, t-test statistic;