Clinical Analysis Of Donation After Cardiac Death Kidney Transplantation

Objective:To analysis the outcomes of donation after cardiac death(DCD)kidney transplantation and the risk factors of delayed graft function(DGF).Methods:We retrospectively analyzed 92 recipients of DCD kidney transplantation from January 2015 to December 2016 in our hospital and investigated the 1-year recipient survival rate,the 1-year allograft survival rate and postoperative complications after DCD kidney transplantation.We analyzed the effect of the recipient age on DCD kidney transplantation and the risk factors of delayed graft function(DGF)by single factor analysis and logistic regression analysis.Results:1.The 1-year recipient survival rate and the 1-year allograft survival rate were97.7%(86/88)and 94.3%(83/88),respectively.The incidence rate of Post-kidney transplantation pneumonia was 19.6%(18/92).2.The recipient age had marked effect on recovery time of renal function(z=-5.151,P<0.001),but it had not marked effect on the 1-year recipient survivalrate(χ~2=0,P=1),the1-yearallograftsurvivalrate(χ~2=0.071,P=0.79),DGF(χ~2=0.045,P=0.833)and postoperative complications after DCD kidney transplantation(P=0.982).3.The incidence of DGF was 20.7%(19/92).Recipient sex(χ~2=0.295,P=0.587),the modus of dialysis(P=0.369),warm ischemia time(WIT)(χ~2=0.235,P=0.628)and blood pressure in open blood vessels(χ~2=0.045,P=0.833)were not risk foctors of DGF by single factor analysis.The mean recipient age for DGF and IGF were(38.4±9.6)years and(38.1±9.9)years(t=-0.118,P=906),The mean preoperative serum creatinine of recipientsforDGFandIGFwere(1069.7±352.1)μmol/L and(996.0±319.5)μmol/L(t=-0.877,P=0.383),were not risk foctors of DGF.The preoperative dialysis time of recipients≥14 months(χ~2=6.211,P=0.013)and cold ischema time(CIT)>8 hours(χ~2=6.408,P=0.011)were risk factors of DGF.4.In the logistic regression analysis,the preoperative dialysis time of recipients≥14 months(P=0.015,OR=7.185,95%CI 1.468~35.170)and cold ischema time(CIT)>8 hours(P=0.009,OR=4.479,95%CI 1.464~13.649)were independent risk factors of DGF.Conclusions:1.The 1-year recipient survival rate and the 1-year allograft survival rate are very high.DCD kidney transplantation is an effective way to expand the source of donor pool.2.Recipient age is not a limitation of DCD kidney transplantation.DCD kidney transplantation can also be performed in middle-aged and elderly patients.3.The most common complication of DCD kidney transplantation is pneumonia.Pneumonia is the primary cause of death in DCD kidney transplantation.4.The preoperative dialysis time of recipients≥14 months and cold ischema time(CIT)>8 hours are independent risk factors of DGF.