Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA.
Transplantation. 2010 Oct 27;90(8):882-90. doi: 10.1097/TP.0b013e3181f2c962.
Hypothermic machine perfusion (MP) preservation is used for all deceased donor kidney transplants at our center. Kidneys are placed in cold storage at retrieval, then transferred to MP on arrival. Because a lack of consensus regarding optimal use of MP still exists, we evaluated the overall impact of using MP at our center and the prognostic value of MP (Pump) time.
We retrospectively analyzed 339 adult, primary deceased donor kidney transplant recipients who were pooled across three prospective, randomized immunosuppression trials (since 2000) at our center. In addition to providing overall results for delayed graft function (DGF) (requirement for dialysis in the first week), slow graft function (SGF), first biopsy-proven acute rejection (BPAR), and graft failure, stepwise logistic and Cox regression analyses were used to determine the prognostic value of pump time, particularly after controlling for other significant prognosticators.
Mean cold storage and pump times were 6.6 and 26.7 hr, consistent across immunosuppression protocols. Overall DGF and SGF rates were 4.4% (15/339) and 12.1% (41/339). DGF was equally low for pump time less than 24 vs. more than or equal to 24 hr, 5.2% (6/116) vs. 4.0% (9/223) (P=0.63), with similar results after adjusting for known DGF predictors. A significantly lower first BPAR rate was observed for longer pump time (as a continuous variable) among more immunologically active recipients (those having more risk factors: DGF, age <50 yr, and non-white) (univariable P=0.005; multivariable P=0.009), with an estimated hazard ratio of 0.43 (P=0.006) favoring pump time more than or equal to 24 hr among those with more than or equal to two risk factors. CONCLUSIONS.: In this single-center, observational study, MP with prolonged pump times was associated with low DGF/SGF and first BPAR rates, supporting continued use of MP.
低温机器灌注 (MP) 保存用于我们中心所有已故供体肾脏移植。肾脏在取回时放置在冷藏中，然后在到达时转移到 MP。由于对于 MP 的最佳使用仍然存在共识，我们评估了我们中心使用 MP 的整体影响以及 MP（泵）时间的预后价值。
我们回顾性分析了我们中心三个前瞻性、随机免疫抑制试验（自 2000 年以来）中汇集的 339 名成年、原发性已故供体肾脏移植受者。除了提供延迟移植物功能障碍（DGF）（第一周需要透析）、移植物功能缓慢（SGF）、首次活检证实的急性排斥反应（BPAR）和移植物衰竭的总体结果外，还使用逐步逻辑和 Cox 回归分析来确定泵时间的预后价值，特别是在控制其他重要预后因素后。
平均冷藏和泵时间分别为 6.6 和 26.7 小时，在免疫抑制方案中保持一致。总体 DGF 和 SGF 发生率分别为 4.4%（15/339）和 12.1%（41/339）。泵时间小于 24 小时与大于或等于 24 小时的 DGF 发生率相同，分别为 5.2%（6/116）和 4.0%（9/223）（P=0.63），在调整已知 DGF 预测因素后结果相似。在免疫活性更高的受者（具有更多危险因素：DGF、<50 岁和非白人）中，较长的泵时间（作为连续变量）观察到第一 BPAR 率显著降低（单变量 P=0.005；多变量 P=0.009），具有更多危险因素的受者中泵时间大于或等于 24 小时的估计风险比为 0.43（P=0.006）。
在这项单中心观察性研究中，延长泵时间的 MP 与低 DGF/SGF 和第一 BPAR 率相关，支持继续使用 MP。
