Department of Infection, Immunity and Inflammation, Transplant Group, University of Leicester, University Hospitals of Leicester, Leicester General Hospital, U.K.
Med Sci Monit. 2011 Jan;17(1):BR27-33. doi: 10.12659/msm.881326.
The Two layer method (TLM) has been extremely successful in the preservation of the pancreas. However, this has not been thoroughly investigated in other organs or in clinically relevant large animal models. The aim of this study was to assess the effects of TLM in a large animal model of kidney preservation.
MATERIAL/METHODS: Porcine kidneys were retrieved after 10 minutes of warm ischaemic injury and flushed with 300 ml UW solution at 4°C. Kidneys were then either placed in University of Wisconsin solution (UW) or TLM using pre-oxygenated perfluorodecalin and UW. Kidneys were stored for 18 hours at 4°C then reperfused with oxygenated autologous blood to assess renal function.
Renal blood flow (RBF) was significantly lower and intra-renal resistance (IRR) higher in TLM compared to UW group [Area under the curve (AUC) RBF, UW; 427±168 vs TLM; 247±55 ml/min/100g.h; P=0.041, AUC IRR, UW; 7.7±2.2 vs TLM; 10.5±1.9 ml/min/mmHg; P=0.041]. Levels of creatinine clearance (CrCl) were significantly lower in TLM group [AUC CrCl, UW; 1.8±1.0 vs TLM; 0.6±0.4 ml/min/100 g.h; P=0.034]. Levels of lipid peroxidation were significantly lower in TLM group [8-isoprostane/Cr ratio 3h; UW 3338±896 vs TLM 2072±886 pg/ml/mmol/L; P=0.04]. Levels of total nitric oxide were significantly higher in TLM group (P=0.009).
TLM did not improve the preservation condition of porcine kidneys. Furthermore, there appeared to be increased inflammation, endothelial injury and reduced renal function compared to preservation with UW. Further experimental work is needed to determine the role of PFC in kidney preservation.
双层法（TLM）在胰腺保存方面取得了巨大成功。然而，这在其他器官或临床相关的大型动物模型中尚未得到彻底研究。本研究旨在评估 TLM 在大型动物肾脏保存模型中的效果。
材料/方法：猪肾在 10 分钟的温热缺血损伤后取出，并在 4°C 下用 300ml UW 溶液冲洗。肾脏随后放置在 UW 溶液或使用预充氧全氟化碳和 UW 的 TLM 中。肾脏在 4°C 下储存 18 小时，然后用含氧自体血液再灌注以评估肾功能。
TLM 组的肾血流（RBF）明显低于 UW 组，肾内阻力（IRR）明显高于 UW 组[RBF 曲线下面积（AUC），UW 组 427±168ml/min/100g.h；TLM 组 247±55ml/min/100g.h；P=0.041，IRR AUC，UW 组 7.7±2.2ml/min/mmHg；TLM 组 10.5±1.9ml/min/mmHg；P=0.041]。TLM 组的肌酐清除率（CrCl）水平明显低于 UW 组[AUC CrCl，UW 组 1.8±1.0ml/min/100g.h；TLM 组 0.6±0.4ml/min/100g.h；P=0.034]。TLM 组的脂质过氧化水平明显低于 UW 组[8-异前列腺素/Cr 比值 3h；UW 组 3338±896pg/ml/mmol/L；TLM 组 2072±886pg/ml/mmol/L；P=0.04]。TLM 组的总一氧化氮水平明显升高（P=0.009）。
TLM 并未改善猪肾的保存条件。此外，与 UW 保存相比，TLM 似乎会增加炎症、内皮损伤和降低肾功能。需要进一步的实验工作来确定 PFC 在肾脏保存中的作用。
