[2007.5.24][转贴][APTX青山病院]无心跳和有心跳尸体供体肾移植的移植效果比较（有心

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Title：Outcome of Kidney Transplantation From Nonheart-Beating Versus Heart-Beating Cadaveric Donors.

Authors：Kokkinos C, Antcliffe D, Nanidis T, Darzi AW, Tekkis P, Papalois V.

Source：Transplantation. 2007 May 15;83(9):1193-1199.

Abstract:BACKGROUND.: This study aimed to assess outcomes of kidney transplants from nonheart-beating (NHB) compared with heart-beating (HB) cadaveric donors with meta-analytical techniques. METHODS.: A literature search was performed for studies comparing kidney transplants from NHB vs. HB cadaveric donors between 1992 and 2005. The following outcomes were evaluated: warm and cold ischemia times, primary nonfunction, delayed graft function, length of hospital stay, acute graft rejection, patient and graft survival, and post-transplant serum creatinine. RESULTS.: Eighteen comparative studies of 114,081 patients matched the selection criteria; 1,858 received kidney from NHB and 112,223 from HB donor. Warm ischemia time was significantly longer for the NHB group by 24 min (P<0.001). Cold ischemia time was similar for the two groups (P=0.97). The incidence of primary nonfunction and delayed graft function was 2.4 times (P<0.001) and 3.6 times (P<0.001) greater, respectively, in the NHB group. Length of hospital stay was longer for the NHB group by 4.6 days (P<0.001). The 6-month, 2-year, and 5-year patient survival were similar between the two groups. The incidence of acute rejection was similar between the two groups whereas the initial graft survival advantage in favor of the HB group diminished gradually over the course of time. There was no statistically significant difference between the two groups for the recipient serum creatinine levels at 3 and 12 months after transplantation. CONCLUSION.: NHB donors carry the potential of expanding the cadaveric kidney pool. Although, transplants from NHB donors are associated with a greater incidence of early adverse events, long-term outcomes appear comparable with those of transplants from HB donors.

附注：有关概念链接UK guidance for non-heart-beating donation：http://bja.oxfordjournals.org/cgi/reprint/95/5/592.pdf

wangyuankai

Title：Outcome of Kidney Transplantation From Nonheart-Beating Versus Heart-Beating Cadaveric Donors.
题目：无心跳和有心跳尸体供体肾移植的移植效果比较

Authors：Kokkinos C, Antcliffe D, Nanidis T, Darzi AW, Tekkis P, Papalois V.
作者：Kokkinos C, Antcliffe D, Nanidis T, Darzi AW, Tekkis P, Papalois V.

Source：Transplantation. 2007 May 15;83(9):1193-1199.
来源：《移植学》. 2007 May 15;83(9):1193-1199.

Abstract:摘要：

BACKGROUND.: This study aimed to assess outcomes of kidney transplants from nonheart-beating (NH compared with heart-beating (H cadaveric donors with meta-analytical techniques.
背景：本研究的目的是为了用荟萃分析方法来评估无心跳（NHB）和有心跳（HB）尸体供体肾移植的移植效果。

METHODS.: A literature search was performed for studies comparing kidney transplants from NHB vs. HB cadaveric donors between 1992 and 2005.
方法：我们检索了1992年到2005年间对无心跳和有心跳尸体供体肾移植进行比较的相关文献。

The following outcomes were evaluated: warm and cold ischemia times, primary nonfunction, delayed graft function, length of hospital stay, acute graft rejection, patient and graft survival, and post-transplant serum creatinine.
对以下指标进行了评估：热缺血和冷缺血时间、原发性无功能、移植肾功能延迟恢复、住院时间、急性排斥反应、病人及移植肾存活时间、移植后血肌酐水平。

RESULTS.: Eighteen comparative studies of 114,081 patients matched the selection criteria; 1,858 received kidney from NHB and 112,223 from HB donor.
结果：共18项比较性研究中的114081名病人符合纳入标准，其中1858名接受无心跳尸体供体肾移植，112223名接受有心跳尸体供体肾移植。

Warm ischemia time was significantly longer for the NHB group by 24 min (P<0.001). Cold ischemia time was similar for the two groups (P=0.97).
NHB组热缺血时间（比HB组）延长了24分钟（P<0.001）。两组的冷缺血时间无明显差异（P=0.97）。

The incidence of primary nonfunction and delayed graft function was 2.4 times (P<0.001) and 3.6 times (P<0.001) greater, respectively, in the NHB group. Length of hospital stay was longer for the NHB group by 4.6 days (P<0.001).
NHB组的原发性无功能和移植肾功能延迟恢复的发生率分别（比HB组）多了2.4次（P<0.001）和3.6次（P<0.001）。NHB组平均住院时间延长了4.6天（P<0.001）。

The 6-month, 2-year, and 5-year patient survival were similar between the two groups.
两组病人的6个月、2年和5年生存率无明显差异。

The incidence of acute rejection was similar between the two groups whereas the initial graft survival advantage in favor of the HB group diminished gradually over the course of time.
两组的急性排斥反应发生率无明显差异，而HB组在移植肾早期存活率方面的优势将随着时间推移而逐渐消失。

There was no statistically significant difference between the two groups for the recipient serum creatinine levels at 3 and 12 months after transplantation.
两组受体的移植后3个月和12个月血肌酐水平无显著统计学差异。

CONCLUSION.: NHB donors carry the potential of expanding the cadaveric kidney pool. Although, transplants from NHB donors are associated with a greater incidence of early adverse events, long-term outcomes appear comparable with those of transplants from HB donors.
结论：NHB供体可扩大尸体肾的来源。尽管无心跳尸体供体的肾移植早期不良事件发生率较高，但远期效果并不比有心跳尸体供体肾移植差。

编译：
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【据《移植学》2007年5月报道】：题目：无心跳和有心跳尸体供体肾移植的移植效果比较（作者Kokkinos等）

背景：本研究的目的是为了用荟萃分析方法来评估无心跳（NHB）和有心跳（HB）尸体供体肾移植的移植效果。方法：我们检索了1992年到2005年间对无心跳和有心跳尸体供体肾移植进行比较的相关文献。对以下指标进行了评估：热缺血和冷缺血时间、原发性无功能、移植肾功能延迟恢复、住院时间、急性排斥反应、病人及移植肾存活时间、移植后血肌酐水平。结果：共18项比较性研究中的114081名病人符合纳入标准，其中1858名接受无心跳尸体供体肾移植，112223名接受有心跳尸体供体肾移植。NHB组热缺血时间（比HB组）延长了24分钟（P<0.001）。两组的冷缺血时间无明显差异（P=0.97）。NHB组的原发性无功能和移植肾功能延迟恢复的发生率分别（比HB组）多了2.4次（P<0.001）和3.6次（P<0.001）。NHB组平均住院时间延长了4.6天（P<0.001）。两组病人的6个月、2年和5年生存率无明显差异。两组的急性排斥反应发生率无明显差异，而HB组在移植肾早期存活率方面的优势将随着时间推移而逐渐消失。两组受体的移植后3个月和12个月血肌酐水平无显著统计学差异。结论：NHB供体可扩大尸体肾的来源。尽管无心跳尸体供体的肾移植早期不良事件发生率较高，但远期效果并不比有心跳尸体供体肾移植差。