Maathuis Mark-Hugo J, Manekeller Steffen, van der Plaats Arjan, Leuvenink Henri G D, 't Hart Nils A, Lier A Bastiaan, Rakhorst Gerhard, Ploeg Rutger J, Minor Thomas
Surgical Research Laboratory, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Ann Surg. 2007 Dec;246(6):982-8; discussion 989-91. doi: 10.1097/SLA.0b013e31815c4019.
To study graft function and ischemia/reperfusion injury of porcine kidneys after preservation with the new Groningen Machine Perfusion (GMP) system versus static cold storage (CS).
The increasing proportion of marginal and nonheart beating donors necessitates better preservation methods to maintain adequate graft viability. Hypothermic machine preservation (HMP) is a promising alternative to static CS. We have therefore developed and tested an HMP device, which is portable and actively oxygenates the perfusate via an oxygenator. The aim of the present study was to examine the efficacy of the GMP system in a transplantation experiment.
In a porcine autotransplantation model, kidneys were retrieved and either cold stored in University of Wisconsin CS for 20 hours at 4 degrees C or subjected to HMP using University of Wisconsin machine perfusion at 4 degrees C with 2 different pressure settings: 30/20 mm Hg or 60/40 mm Hg.
HMP at 30/20 mm Hg was found to better preserve the viability of kidneys reflected by improved cortical microcirculation, less damage to the proximal tubule, less damage mediated by reactive oxygen species, less proinflammatory cytokine expression, and better functional recovery after transplantation. However, high perfusion pressures (60/40 mm Hg) resulted in higher expression of von Willebrand factor and monocyte chemotactic peptide-1 in postpreservation biopsies and subsequent graft thrombosis in 2 kidneys.
It is concluded that the GMP system improves kidney graft viability and perfusion pressures are critically important for outcome.
研究采用新型格罗宁根机器灌注（GMP）系统与静态冷藏（CS）保存猪肾后的移植功能及缺血/再灌注损伤。
边缘供体和非心脏跳动供体比例的增加使得需要更好的保存方法来维持足够的移植物活力。低温机器保存（HMP）是静态CS的一种有前景的替代方法。因此，我们开发并测试了一种HMP设备，该设备便于携带且通过氧合器对灌注液进行主动氧合。本研究的目的是在移植实验中检验GMP系统的效果。
在猪自体移植模型中，取出肾脏，要么在4℃下用威斯康星大学CS液冷藏20小时，要么在4℃下使用威斯康星大学机器灌注进行HMP，设置2种不同的压力：30/20 mmHg或60/40 mmHg。
发现30/20 mmHg的HMP能更好地保存肾脏活力，表现为皮质微循环改善、近端小管损伤减轻、活性氧介导的损伤减轻、促炎细胞因子表达减少以及移植后功能恢复更好。然而，高灌注压力（60/40 mmHg）导致保存后活检中血管性血友病因子和单核细胞趋化蛋白-1的表达更高，且随后有2个肾脏发生移植物血栓形成。
得出结论，GMP系统可提高肾移植活力，灌注压力对结果至关重要。
