Sonnenday Christopher J, Cooper Matthew, Kraus Edward, Gage Fred, Handley Christopher, Montgomery Robert A
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
Transplantation. 2003 Jun 27;75(12):2029-33. doi: 10.1097/01.TP.0000065296.35395.FD.
Pulsatile perfusion (PP) is used by some centers to provide information that may aid in the selection of cadaveric renal allografts for transplantation. However, basing organ acceptance on PP parameters alone may lead to the discarding of kidneys from otherwise suitable donors. In this case series, we report the reevaluation and transplantation of kidneys refused by other centers after evaluation with PP.
Retrospective review of 14 cadaveric kidneys imported for repeat PP at our center after initially poor PP parameters from an outside organ procurement organization resulted in refusal by multiple centers.
Median age of donors was 46 (range 21-64), and mean terminal serum creatinine was 1.3+/-0.6 mg/dL. Despite favorable donor characteristics, each kidney was refused by an average of 9.3 centers. Poor PP parameters and concerns about donor quality were the reasons for refusal in the majority of cases. Pulsatile-perfusion parameters at the outside center were poor: mean flow of 103 mL/min/100 g and mean resistance of 0.321 mm Hg/(mL/min/100 g). Repeat PP parameters at our center after importation were markedly improved (flow=167 mL/min/100 g and resistance=0.195 mm Hg/[mL/min/100 g]). Eleven of 14 kidneys were transplanted and currently have acceptable graft function (mean serum creatinine=1.6 mg/dL at a median follow-up of 12 months).
This series describes the successful transplantation of 11 kidneys from acceptable donors that were initially discarded by multiple centers after poor PP parameters were obtained. The good allograft function in these organs emphasizes the importance of considering all donor factors when making allocation decisions.
一些中心采用搏动灌注（PP）来提供有助于选择尸体肾移植供体的信息。然而，仅根据PP参数来决定是否接受器官可能会导致丢弃原本合适供体的肾脏。在本病例系列中，我们报告了经PP评估后被其他中心拒绝的肾脏的重新评估及移植情况。
回顾性分析14例尸体肾，这些肾脏最初因来自外部器官获取组织的PP参数不佳而被多个中心拒绝，后被转运至我们中心进行重复PP评估。
供体的中位年龄为46岁（范围21 - 64岁），终末期血清肌酐平均为1.3±0.6mg/dL。尽管供体特征良好，但每个肾脏平均被9.3个中心拒绝。PP参数不佳以及对供体质量的担忧是大多数情况下被拒绝的原因。外部中心的搏动灌注参数较差：平均流量为103mL/min/100g，平均阻力为0.321mmHg/（mL/min/100g）。在我们中心重新评估后，这些肾脏的PP参数显著改善（流量 = 167mL/min/100g，阻力 = 0.195mmHg/[mL/min/100g]）。14例肾脏中有11例进行了移植，目前移植肾功能良好（中位随访12个月时血清肌酐平均为1.6mg/dL）。
本系列描述了11例来自可接受供体的肾脏成功移植，这些肾脏最初因PP参数不佳而被多个中心丢弃。这些器官良好的移植肾功能强调了在做出分配决策时考虑所有供体因素的重要性。
