Early graft losses in paired kidney exchange: Experience from 10 years of the National Kidney Registry.,American Journal of Transplantation

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Early graft losses in paired kidney exchange: Experience from 10 years of the National Kidney Registry.
American Journal of Transplantation ( IF 8.9 ) Pub Date : 2020-01-29 , DOI: 10.1111/ajt.15778
Jennifer Verbesey ₁ , Alvin G Thomas _{2,

3} , Matt Ronin ₄ , Jennifer Beaumont ₅ , Amy Waterman _{5,

6} , Dorry L Segev _{3,

7,

8} , Stuart M Flechner ₉ , Matthew Cooper ₁

Affiliation

Cooperative kidney paired donation (KPD) networks account for an increasing proportion of all living donor kidney transplants in the United States. There are sparse data on the rate of primary nonfunction (PNF) losses and their consequences within KPD networks. We studied National Kidney Registry (NKR) transplants (February 14, 2009 to December 31, 2017) and quantified PNF, graft loss within 30 days of transplantation, and graft losses in the first-year posttransplant and assessed potential risk factors. Of 2364 transplants, there were 38 grafts (1.6%) lost within the first year, 13 (0.5%) with PNF. When compared to functioning grafts, there were no clinically significant differences in blood type compatibility, degree of HLA mismatch, number of veins/arteries, cold ischemia, and travel times. Of 13 PNF cases, 2 were due to early venous thrombosis, 2 to arterial thrombosis, and 2 to failure of desensitization and development of antibody-mediated rejection (AMR). Given the low rate of PNF, the NKR created a policy to allocate chain-end kidneys to recipients with PNF following event review and attributable to surgical issues of donor nephrectomy. It is expected that demonstration of low incidence of poor early graft outcomes and the presence of a "safety net" would further encourage program participation in national KPD.

中文翻译：

配对肾脏交换中的早期移植物损失：国家肾脏登记处 10 年来的经验。

在美国，合作肾脏配对捐赠（KPD）网络在所有活体肾移植中所占的比例越来越大。关于 KPD 网络中原发性无功能 (PNF) 损失率及其后果的数据很少。我们研究了国家肾脏登记处 (NKR) 移植（2009 年 2 月 14 日至 2017 年 12 月 31 日），量化了 PNF、移植后 30 天内的移植物丢失以及移植后第一年的移植物丢失，并评估了潜在的风险因素。在 2364 例移植物中，第一年内有 38 例（1.6%）移植物丢失，其中 13 例（0.5%）患有 PNF。与功能移植物相比，血型相容性、HLA 不匹配程度、静脉/动脉数量、冷缺血和行进时间没有临床显着差异。在 13 例 PNF 病例中，2 例是由于早期静脉血栓形成，2 例是由于动脉血栓形成，2 例是由于脱敏失败和发生抗体介导的排斥反应 (AMR)。鉴于 PNF 发生率较低，NKR 制定了一项政策，在事件审查后并归因于供体肾切除术的手术问题，将链端肾脏分配给患有 PNF 的受者。预计早期移植结果不良的发生率较低以及“安全网”的存在将进一步鼓励参与国家 KPD 计划。

更新日期：2020-01-29

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