Polyak M M, Arrington B O, Kapur S, Stubenbord W T, Kinkhabwala M
Department of Surgery, New York Presbyterian Hospital-Weill Medical College, Cornell University, New York, USA.
Transplantation. 2000 Jul 15;70(1):202-5.
Reduced glutathione (GSH), a component of University of Wisconsin (UW) solution, is reported to oxidize during storage. Consequently the commercial manufacturer of UW recommends the supplemental addition of GSH to UW before utilization. We investigated the influence of supplemental GSH during cold ischemia on early renal allograft function.
One hundred kidneys were locally procured from heart-beating donors, preserved in our laboratory, and transplanted during an 18-month period. Selected donor, preservation, and outcome characteristics were collected and compared by presence of supplemental GSH and method of preservation. All kidneys were randomized to receive 3.0 mM supplemental GSH to perfusate or no supplementation (control) and were preserved by either cold storage (CS) in UW or machine perfused (MP) in UW-machine perfusate solution (MPS). During MP, perfusion characteristics (flow, resistance, perfusate electrolytes, and pH) were serially measured.
There were no significant differences among the groups when the donor characteristics of age, serum creatinine, and intra-operative urine output were compared. Preservation characteristics were similar among the groups with the exception of cold ischemia time, which was longer in the MP group compared to CS (26.1 h vs. 21.9 h, P=0.03). When compared with CS, kidneys preserved by MP exhibited a 33.4% increase in immediate function (93% vs. 62%, P=0.01), a corresponding 29.4% decrease in the incidence of delayed graft function (10% vs. 34%, P=0.02), and a 10% improvement in short-term (6-month) graft survival (98% vs. 88%, P=0.02). The addition of GSH supplementation to perfusate resulted in no significant differences in graft outcomes.
Despite recommendations by the manufacturer that UW solution be routinely supplemented with GSH, supplemental GSH does not influence early renal allograft function. Our data suggest that a far greater beneficial impact on early graft function is achieved by machine perfusion. We conclude that GSH supplementation of commercially available UW is not necessary.
据报道，威斯康星大学（UW）溶液的成分之一还原型谷胱甘肽（GSH）在储存期间会发生氧化。因此，UW的商业制造商建议在使用前向UW中额外添加GSH。我们研究了冷缺血期间补充GSH对早期肾移植功能的影响。
从心脏跳动的供体处本地获取100个肾脏，在我们的实验室中保存，并在18个月内进行移植。通过补充GSH的存在和保存方法收集并比较选定的供体、保存和结果特征。所有肾脏随机分为接受3.0 mM补充GSH至灌注液组或不补充组（对照组），并通过在UW中冷保存（CS）或在UW机器灌注液（MPS）中进行机器灌注（MP）进行保存。在MP期间，连续测量灌注特征（流量、阻力、灌注液电解质和pH）。
比较年龄、血清肌酐和术中尿量等供体特征时，各组之间无显著差异。除冷缺血时间外，各组的保存特征相似，MP组的冷缺血时间比CS组长（26.1小时对21.9小时，P = 0.03）。与CS相比，通过MP保存的肾脏立即功能增加33.4%（93%对62%，P = 0.01），移植肾功能延迟发生率相应降低29.4%（10%对34%，P = 0.02），短期（6个月）移植存活率提高10%（98%对88%，P = 0.02）。向灌注液中添加GSH补充剂对移植结果无显著差异。
尽管制造商建议常规向UW溶液中补充GSH，但补充GSH并不影响早期肾移植功能。我们的数据表明，机器灌注对早期移植功能有更大的有益影响。我们得出结论，无需向市售的UW中补充GSH。
