Division of Nephrology, Department of Medicine, Hypertension and Solid Organ Transplant, University of Florida, Gainesville, FL, USA.
Am J Transplant. 2012 Oct;12(10):2774-80. doi: 10.1111/j.1600-6143.2012.04179.x. Epub 2012 Jul 23.
Organ storage techniques have been under scrutiny to determine the best preservation method, particularly in donation after cardiac death (DCD) kidneys. Conflicting literature on the benefit of pulsatile perfusion (PP) over cold storage (CS) warrants further investigation. We analyzed the risk of developing delayed graft function (DGF) in recipients of DCD and donation after brain death (DBD) kidneys undergoing PP or CS. We stratified on basis of cold ischemic time (CIT) to determine the interaction of preservation techniques, CIT and DCD kidneys on developing DGF. Of 54 136 recipients, 4923 received DCD kidneys of which 3330 (67%) underwent PP. Of 49 213 DBD recipients, 7531 (15%) underwent PP. DCD had a higher risk of DGF versus DBD (adjusted odds ratio, AOR 3.2; 3.0-3.5). PP kidneys had less DGF (AOR 0.59; 0.56-0.63) compared to CS. Interaction models of method by donor type referenced to PP/DBD revealed CS/DBD kidneys had higher DGF (AOR 1.8; 1.7-1.9), whereas CS/DCD kidneys had the highest risk of DGF (AOR 5.01; 4.43-5.67). Even though suggestive for a benefit of PP on DGF, this retrospective analysis cannot address whether this is an intrinsic effect of PP or is associated with the logistics of PP such as discard of DCD kidneys based on pump parameters.
器官保存技术一直受到关注，以确定最佳的保存方法，特别是在心脏死亡后捐献（DCD）肾脏中。关于搏动性灌注（PP）优于低温保存（CS）的益处的相互矛盾的文献需要进一步研究。我们分析了接受 DCD 和脑死亡后捐献（DBD）肾脏的患者中，接受 PP 或 CS 后发生延迟移植物功能障碍（DGF）的风险。我们根据冷缺血时间（CIT）进行分层，以确定保存技术、CIT 和 DCD 肾脏在发生 DGF 方面的相互作用。在 54136 名受者中，4923 名接受了 DCD 肾脏，其中 3330 名（67%）接受了 PP。在 49213 名 DBD 受者中，7531 名（15%）接受了 PP。与 DBD 相比，DCD 发生 DGF 的风险更高（调整后的优势比，AOR 3.2；3.0-3.5）。与 CS 相比，PP 肾脏发生 DGF 的风险较低（AOR 0.59；0.56-0.63）。以 PP/DBD 为参照的供体类型的方法相互作用模型显示，CS/DBD 肾脏的 DGF 发生率更高（AOR 1.8；1.7-1.9），而 CS/DCD 肾脏的 DGF 风险最高（AOR 5.01；4.43-5.67）。尽管这表明 PP 对 DGF 有益，但这项回顾性分析无法确定这是 PP 的内在作用，还是与 PP 的后勤工作有关，例如根据泵参数丢弃 DCD 肾脏。
