Polyak M M, Arrington B O, Kapur S, Stubenbord W T, Kinkhabwala M
Organ Preservation Unit, Center for Organ Preservation and Transplantation Research, The New York Presbyterian Hospital-Weill Medical College of Cornell University, New York, USA.
Transplantation. 2000 Jan 15;69(1):184-6. doi: 10.1097/00007890-200001150-00033.
It has been suggested that pharmacologic conditioning of the donor before organ procurement may protect the renal allograft from injuries associated with the cold ischemic period. We compared the administration of two vasoactive agents before organ procurement to: (1) determine their influence on machine perfusion characteristics and (2) determine their impact on delayed graft function (DGF) in transplanted renal allografts.
Between January 1997 and December 1998, 150 kidneys were procured from heart-beating donors and preserved in our laboratory by machine perfusion (MP) or cold storage (CS). The following vasoactive agents were randomly administered to the donor 5 min before aortic cross clamp: phentolamine mesylate (PM) or hydralazine (H). The control groups received no donor conditioning. Kidneys were grouped as follows: (1) MP+PM, (2) MP+H, (3) MP, (4) CS+PM, (5) CS+H, (6) CS. 10 mg PM/50 kg donor weight was administered to the PM groups and 20 mg H/50 kg donor weight was administered to the H groups. DGF was defined as the need for dialysis within the first 7 days after the transplant.
MP+PM increased renal flow by 12% and decreased renal resistance by 18% compared with the MP+H group, and increased renal flow by 23% and decreased renal resistance by 30% compared with the MP group. Moreover, the MP+PM group was associated with improved early allograft function.
Donor treatment with PM immediately before aortic cross-clamp is associated with improved machine perfusion dynamics (renal flow and renal resistance) and lower incidence of DGF compared with donor treatment with H or no treatment. Moreover, MP of renal allografts was associated with improved early function compared with CS grafts.
有人提出，在器官获取前对供体进行药物预处理可能会保护肾移植受者免受与冷缺血期相关的损伤。我们比较了在器官获取前给予两种血管活性药物，以：（1）确定它们对机器灌注特征的影响；（2）确定它们对移植肾延迟移植肾功能（DGF）的影响。
在1997年1月至1998年12月期间，从心跳骤停供体获取150个肾脏，并在我们的实验室通过机器灌注（MP）或冷保存（CS）进行保存。在主动脉交叉钳夹前5分钟，将以下血管活性药物随机给予供体：甲磺酸酚妥拉明（PM）或肼屈嗪（H）。对照组未对供体进行预处理。肾脏分组如下：（1）MP + PM组，（2）MP + H组，（3）MP组，（4）CS + PM组，（5）CS + H组，（6）CS组。PM组给予每50 kg供体体重10 mg PM，H组给予每50 kg供体体重20 mg H。DGF定义为移植后第1个7天内需要透析。
与MP + H组相比，MP + PM组肾血流量增加12%，肾阻力降低18%；与MP组相比，肾血流量增加23%，肾阻力降低30%。此外，MP + PM组移植肾功能早期改善。
与给予H或不进行处理相比，在主动脉交叉钳夹前立即用PM处理供体，与改善机器灌注动力学（肾血流量和肾阻力）及降低DGF发生率相关。此外，与CS保存的移植肾相比，MP保存的移植肾早期功能改善。
