L giewska B, Pacholczyk M, Chmura A, Adadyński L, Szostek M, Michalak G, Ostrowski K, Wałaszewski J, Rowiński W
Department of General and Transplantation Surgery, Warsaw Medical School, Poland.
Transpl Int. 1994;7 Suppl 1:S476-8. doi: 10.1111/j.1432-2277.1994.tb01422.x.
The incidence of acute tubular necrosis ATN after cadaveric kidney transplantation in our centre has been in the range of 50%. A prospective study was carried out in 1991 and 1992 to assess the effect of in situ perfusion and hypothermic storage of kidneys harvested from brain-dead haemodynamically stable and unstable donors. Three litres of Ringer's solution were used for in situ perfusion. In 40 cases, the kidneys were stored in Euro-Collins (EC) solution and in the other 78 cases, in University of Wisconsin (UW) solution. Among the factors that could contribute to ATN, we analysed warm ischaemia time, anastomosis time and cold storage time. Function was considered to be delayed if the patient required posttransplantation dialysis. The donors were considered haemodynamically unstable when hypotension before harvesting was present (BP < 70 mm Hg over 2 h) despite high doses (> 15 microg/kg per minute) of dopamine or when cardiac arrest occurred at the time of harvesting and oliguria had been present for at least 2 h. Haemodynamically stable donors with a BP greater than 80 mm Hg had a normal diuresis. In all donors in this group the dose of dopamine was lower than 10 microg/kg per minute. The study showed that storage in UW solution did not influence the incidence of ATN in kidneys harvested from haemodynamically unstable donors. Differences observed in our study were due to haemodynamic status preceding donor nephrectomy and length of cold storage time.
在我们中心，尸体肾移植后急性肾小管坏死（ATN）的发生率在50%左右。1991年和1992年进行了一项前瞻性研究，以评估对从脑死亡且血流动力学稳定和不稳定的供体获取的肾脏进行原位灌注和低温保存的效果。使用三升林格氏液进行原位灌注。40例中，肾脏保存在欧洲柯林斯（EC）液中，另外78例保存在威斯康星大学（UW）液中。在可能导致ATN的因素中，我们分析了热缺血时间、吻合时间和冷保存时间。如果患者术后需要透析，则认为肾功能延迟。如果在获取前存在低血压（血压<70 mmHg持续2小时以上），尽管使用了高剂量（>15微克/千克每分钟）的多巴胺，或者在获取时发生心脏骤停且少尿已持续至少2小时，则供体被认为血流动力学不稳定。血压大于80 mmHg的血流动力学稳定供体有正常的尿量。该组所有供体中多巴胺的剂量低于10微克/千克每分钟。研究表明，保存在UW液中对从血流动力学不稳定供体获取的肾脏中ATN的发生率没有影响。我们研究中观察到的差异是由于供体肾切除术前的血流动力学状态和冷保存时间的长短。
