Stubenitsky B M, Booster M H, Brasile L, Araneda D, Haisch C E, Kootstra G
Department of Surgery, azM University Hospital, Maastricht, The Netherlands.
Transplantation. 2000 Oct 27;70(8):1254-8. doi: 10.1097/00007890-200010270-00024.
The compounding damage of warm ischemia (WI) followed by cold preservation is a major barrier in renal transplantation. Although the relative effect of WI is not yet well understood, therapeutic strategies have mostly focused on minimizing the pathology seen upon reperfusion from the cold. Our study was designed to examine the effect of restoration of renal metabolism by warm perfusion on graft survival and to investigate the compounding damage of WI.
Using a known critical canine autotransplantation model (1), kidneys were exposed to 30 min WI followed by 24 hr cold storage in Viaspan. They were then either reimplanted directly or first transitioned to 3 hr of warm perfusion with an acellular perfusate before reimplantation. Contralateral kidneys were subjected to 0, 30, or 60 min WI; 24 hr cold storage, and 3 hr warm perfusion.
Transplanted kidneys that were warm perfused before reimplantation had both lower 24 hr posttransplant serum creatinine (median of 3.2 vs. 4.1 mg/dl) and lower peak serum creatinine (median of 4.95 vs. 7.1 mg/dl). Survival rate for warm perfused kidneys was 90% (9/10) vs. 73% (8/11). In the contralateral kidneys, metabolism was affected by the compounding damage of WI. Renal oxygen and glucose consumption diminished significantly, whereas vascular resistance and lactate dehydrogenase-release rose significantly with increasing WI.
The results demonstrate a reduction of reperfusion damage by an acellular ex vivo restoration of renal metabolism. Furthermore, data from the contralateral kidneys substantiates the relative role of WI on metabolism in renal transplantation.
热缺血（WI）后继冷保存的复合损伤是肾移植的主要障碍。尽管WI的相对影响尚未完全明确，但治疗策略大多集中于将冷灌注再灌注时出现的病理损伤降至最低。我们的研究旨在探讨热灌注恢复肾代谢对移植物存活的影响，并研究WI的复合损伤。
使用已知的关键犬自体移植模型（1），将肾脏暴露于30分钟的WI，然后在Viaspan中进行24小时冷保存。然后将它们直接再植入，或者在再植入前先用无细胞灌注液进行3小时的热灌注。对侧肾脏分别进行0、30或60分钟的WI；24小时冷保存和3小时热灌注。
再植入前进行热灌注的移植肾，移植后24小时血清肌酐较低（中位数为3.2 vs. 4.1 mg/dl），血清肌酐峰值也较低（中位数为4.95 vs. 7.1 mg/dl）。热灌注肾脏的存活率为90%（9/10），而未灌注组为73%（8/11）。在对侧肾脏中，代谢受到WI复合损伤的影响。随着WI时间增加，肾氧耗和葡萄糖消耗显著减少，而血管阻力和乳酸脱氢酶释放显著增加。
结果表明，通过无细胞体外恢复肾代谢可减少再灌注损伤。此外，对侧肾脏的数据证实了WI在肾移植代谢中的相对作用。
