Wilson C H, Asher J F, Gupta A, Vijayanand D, Wyrley-Birch H, Stamp S, Rix D A, Soomro N, Manas D M, Jaques B C, Peaston R, Talbot D
The Liver/Renal Unit, The Freeman Hospital, Newcastle-upon-Tyne, United Kingdom.
Transplant Proc. 2007 Mar;39(2):351-2. doi: 10.1016/j.transproceed.2007.01.012.
Intraarterial cooling (IAC) of non-heart-beating donors (NHBD) for renal donation requires a cheap, low-viscosity solution. HTK contains a high hydrogen ion buffer level that theoretically should reduce the observable acidosis associated with ongoing anaerobic metabolism. A retrospective comparison of all retrieved NHBD kidneys as well as of viability on the Organ Recovery Systems Lifeporter machine perfusion circuit was performed with respect to the preservation solution HTK or Marshall's HOC. Forty-two NHBD kidneys (19 HTK and 23 HOC) were machine perfused between February 2004 and May 2005. Most of the HTK kidneys were obtained from uncontrolled donors (12 vs 5; Fisher exact test, P = .01). As a consequence, the glutathione-s-transferase viability assay (411 vs 292 IU/L, P = .12) and the lactate concentrations (2.33 vs 1.94 mmol/L, P = .13) were higher among the HTK cohort. There was evidence of greater buffering capacity in HTK, since the lactate:hydrogen ion ratios were consistently lower during the first 2 perfusion hours (1 hour P = .03, 2 hour P = .02). A linear regression analysis confirmed that this was related to the IAC solution (ANCOVA, P < .001). All controlled donor kidneys passed viability testing and were transplanted. In contrast, 83% (10/12) of the uncontrolled donor kidneys preserved with HTK passed the viability test and were transplanted, compared with only 20% (1/5) of the HOC-treated comparators (Fisher exact test, P = .03). It may be concluded that the postulated advantages of improved pH buffering with HTK appear to have clinical relevance.
用于肾脏捐献的非心脏骤停供体(NHBD)的动脉内冷却(IAC)需要一种廉价、低粘度的溶液。HTK含有高氢离子缓冲水平,理论上应能减少与持续无氧代谢相关的明显酸中毒。对所有获取的NHBD肾脏以及在器官回收系统Lifeporter机器灌注回路上的存活能力,就保存溶液HTK或马歇尔氏HOC进行了回顾性比较。2004年2月至2005年5月期间,对42个NHBD肾脏(19个用HTK、23个用HOC)进行了机器灌注。大多数用HTK保存的肾脏来自非受控供体(12个对5个;Fisher精确检验,P = 0.01)。因此,HTK组中的谷胱甘肽 - S - 转移酶存活能力测定值(411对292 IU/L,P = 0.12)和乳酸浓度(2.33对1.94 mmol/L,P = 0.13)更高。有证据表明HTK具有更大的缓冲能力,因为在前两个灌注小时内乳酸与氢离子的比值一直较低(1小时P = 0.03,2小时P = 0.02)。线性回归分析证实这与IAC溶液有关(协方差分析,P < 0.001)。所有受控供体的肾脏均通过存活能力测试并进行了移植。相比之下,用HTK保存的非受控供体肾脏中有83%(10/12)通过了存活能力测试并进行了移植,而用HOC处理的对照肾脏中只有20%(1/5)通过(Fisher精确检验,P = 0.03)。可以得出结论,HTK改善pH缓冲的假定优势似乎具有临床相关性。