分析机器灌注对供体肾脏的益处：一项临床前研究。

BACKGROUND

Machine perfusion (MP) has potential benefits for marginal organs such as from deceased from cardiac death donors (DCD). However, there is still no consensus on MP benefits. We aimed to determine machine perfusion benefits on kidney grafts.

METHODS

We evaluated kidney grafts preserved in ViaspanUW or KPS solutions either by CS or MP, in a DCD pig model (60 min warm ischemia+24 h hypothermic preservation). Endpoints were: function recovery, quality of function during follow up (3 month), inflammation, fibrosis, animal survival.

RESULTS

ViaspanUW-CS animals did not recover function, while in other groups early follow up showed similar values for kidney function. Alanine peptidase and β-NAG activities in the urine were higher in CS than in MP groups. Oxydative stress was lower in KPS-MP animals. Histology was improved by MP over CS. Survival was 0% in ViaspanUW-CS and 60% in other groups. Chronic inflammation, epithelial-to-mesenchymal transition and fibrosis were lowest in KPS-MP, followed by KPS-CS and ViaspanUW-MP.

CONCLUSIONS

With ViaspanUW, effects of MP are obvious as only MP kidney recovered function and allowed survival. With KPS, the benefits of MP over CS are not directly obvious in the early follow up period and only histological analysis, urinary tubular enzymes and red/ox status was discriminating. Chronic follow-up was more conclusive, with a clear superiority of MP over CS, independently of the solution used. KPS was proven superior to ViaspanUW in each preservation method in terms of function and outcome. In our pre-clinical animal model of DCD transplantation, MP offers critical benefits.

背景

机器灌注（MP）对边缘供体器官（如心脏死亡供体（DCD））具有潜在的益处。然而，对于 MP 的益处仍未达成共识。我们旨在确定 MP 对肾移植物的益处。

方法

我们评估了在 DCD 猪模型中（60 分钟热缺血+24 小时低温保存），使用 ViaspanUW 或 KPS 溶液保存的肾移植物，分别通过 CS 或 MP 进行保存。终点是：功能恢复，随访期间（3 个月）的功能质量，炎症，纤维化，动物存活。

结果

ViaspanUW-CS 动物的功能无法恢复，而在其他组中，早期随访显示肾功能相似。CS 组的尿液中丙氨酸肽酶和β-NAG 活性高于 MP 组。KPS-MP 动物的氧化应激较低。MP 比 CS 更能改善组织学。ViaspanUW-CS 的存活率为 0%，其他组为 60%。慢性炎症，上皮间质转化和纤维化在 KPS-MP 组中最低，其次是 KPS-CS 和 ViaspanUW-MP。

结论

使用 ViaspanUW，MP 的效果明显，只有 MP 肾恢复了功能并允许存活。使用 KPS，在早期随访期间，MP 相对于 CS 的益处并不直接明显，只有组织学分析，尿液管状酶和红/氧化状态具有区分性。慢性随访更具结论性，MP 相对于 CS 具有明显优势，而与所使用的溶液无关。在我们的 DCD 移植临床前动物模型中，MP 提供了关键的益处。