Department of Surgery, University of Western Ontario and Multi-Organ Transplant Program, Ontario, Canada.
J Urol. 2013 Jun;189(6):2214-20. doi: 10.1016/j.juro.2012.11.173. Epub 2012 Dec 3.
Static cold storage is generally used to preserve kidney allografts from deceased donors. Hypothermic machine perfusion may improve the outcome after transplantation but few studies with limited power have addressed this issue. We reviewed evidence of the effectiveness of storing kidneys from deceased donors after cardiac death before transplantation using cold static storage solution or pulsatile hypothermic machine perfusion.
We searched electronic databases in September 2011 for systematic reviews and/or meta-analyses, randomized, controlled trials and studies of other designs that compared delayed graft function and graft survival. Sources included The Cochrane Library, PubMed® and EMBASE®. Studies excluded from review included those that did not discriminate between donation after cardiac death and donation from a neurologically deceased donor. Primary outcomes were delayed graft function and 1-year graft survival. Statistical analysis was done using RevMan (http://ims.cochrane.org/revman).
Nine studies qualified for review. Pulsatile perfusion pumped kidneys from donation after cardiac death donors had decreased delayed graft function compared to kidneys placed in cold storage (OR 0.64, 95% CI 0.43-0.95, p = 0.03). There was a trend toward improved 1-year graft survival in the pulsatile perfusion group but statistical significance was not attained (OR 0.74, 95% CI 0.48-1.13, p = 0.17).
Pulsatile machine perfusion of donation after cardiac death kidneys appears to decrease the delayed graft function rate. We noted no benefit in 1-year graft survival. Due to the great heterogeneity among the trials as well as several confounding factors, the overall impact on allograft function and survival requires more study.
低温静态冷藏通常用于保存来自已故供体的肾脏移植物。低温机器灌注可能会改善移植后的效果，但少数权力有限的研究已经解决了这个问题。我们回顾了使用低温静态保存液或脉动低温机器灌注在心脏死亡后对已故供体的肾脏进行移植前保存的效果证据。
我们于 2011 年 9 月在电子数据库中搜索了系统评价和/或荟萃分析、随机对照试验和其他设计的研究，这些研究比较了延迟移植物功能和移植物存活率。来源包括 Cochrane 图书馆、PubMed®和 EMBASE®。未进行审查的研究排除了那些没有区分心脏死亡后捐赠和神经死亡后捐赠的研究。主要结果是延迟移植物功能和 1 年移植物存活率。使用 RevMan（http://ims.cochrane.org/revman）进行统计分析。
有 9 项研究符合审查条件。与低温储存的肾脏相比，来自心脏死亡供体的搏动性灌注泵肾脏的延迟移植物功能下降（OR 0.64，95%CI 0.43-0.95，p = 0.03）。在搏动性灌注组中，1 年移植物存活率有改善的趋势，但未达到统计学意义（OR 0.74，95%CI 0.48-1.13，p = 0.17）。
搏动性机器灌注心脏死亡供体的肾脏似乎可以降低延迟移植物功能的发生率。我们注意到 1 年移植物存活率没有获益。由于试验之间存在很大的异质性以及几个混杂因素，对同种异体移植物功能和存活率的总体影响需要进一步研究。
