Clinic for General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany.
Nephrol Dial Transplant. 2012 Dec;27(12):4458-63. doi: 10.1093/ndt/gfs321. Epub 2012 Jul 26.
In the Eurotransplant Senior Programme (ESP), kidneys from donors aged ≥ 65 years are preferentially allocated locally and transplanted into patients aged ≥ 65 years on dialysis. The purpose of this study was to analyse whether the results of transplantation in the ESP can be improved by preservation of organs by hypothermic machine perfusion (MP) compared with simple cold storage (CS).
Overall, 85 deceased heart-beating donors ≥ 65 years of age were included in this analysis with follow-up until 1 year post-transplant. For each donor, one kidney was randomly assigned to preservation by CS and the contralateral kidney to MP from organ procurement until transplantation. Delayed graft function (DGF), primary non-function (PNF) and 1-year patient and graft survival rates were evaluated as primary and secondary endpoints.
The median recipient age was 66 years in both groups and the median cold ischaemia time was 11 h for MP and 10.5 h for CS (P = 0.69). The DGF rate was 29.4% for MP and 34.1% for CS (P = 0.58). Only extended duration of cold ischaemia time was an independent risk factor for the development of DGF (odds ratio 1.2, P < 0.0001). PNF was significantly reduced (3.5% MP versus 12.9% CS, P = 0.02). The 1-year patient and graft survival rates were similar for MP and CS (94% versus 95% and 89 versus 81%, P > 0.05). The 1-year graft survival rate was significantly improved after MP in recipients who developed DGF (84% MP versus 48% CS, P = 0.01).
Continuous pulsatile hypothermic MP for kidneys from donors aged ≥ 65 years can reduce the rate of never-functioning kidneys and improve the 1-year graft survival rate of kidneys with DGF. In this small cohort, the known advantage of MP for the reduction of DGF could not be confirmed, possibly due to relatively short cold ischaemia times.
在欧洲器官移植老年人计划（ESP）中，优先将来自年龄≥65 岁的供者的肾脏分配给当地年龄≥65 岁的透析患者。本研究的目的是分析与单纯低温保存（CS）相比，通过低温机器灌注（MP）保存器官是否可以改善 ESP 中的移植结果。
共纳入 85 名年龄≥65 岁的脑死亡供者，随访至移植后 1 年。每位供者的一侧肾脏随机分配接受 CS 保存，另一侧肾脏接受从器官获取到移植的 MP 保存。将延迟移植物功能障碍（DGF）、原发性无功能（PNF）和 1 年患者和移植物存活率作为主要和次要终点进行评估。
两组受体的中位年龄均为 66 岁，MP 组的中位冷缺血时间为 11 小时，CS 组为 10.5 小时（P=0.69）。MP 组的 DGF 发生率为 29.4%，CS 组为 34.1%（P=0.58）。只有冷缺血时间延长是 DGF 发生的独立危险因素（优势比 1.2，P<0.0001）。PNF 明显减少（3.5%MP 与 12.9%CS，P=0.02）。MP 组和 CS 组的 1 年患者和移植物存活率相似（94%对 95%和 89%对 81%，P>0.05）。在发生 DGF 的受者中，MP 后 1 年移植物存活率显著提高（84%MP 与 48%CS，P=0.01）。
对于年龄≥65 岁的供者的肾脏，持续脉冲低温 MP 可降低无功能肾脏的发生率，并提高 DGF 肾脏的 1 年移植物存活率。在这个小队列中，未能证实 MP 降低 DGF 的已知优势，可能是由于冷缺血时间相对较短。
