Keller A K, Kierulf-Lassen C, Møldrup U, Bibby B M, Jespersen B
Institute of Clinical Medicine, Aarhus University Hospital, Skejby, Denmark.
Transplant Proc. 2013 Apr;45(3):1172-7. doi: 10.1016/j.transproceed.2012.10.014.
Little is known about local graft metabolism during warm and cold ischemia before renal transplantation. We sought to characterize local metabolic changes in renal grafts during storage to understand acceptable ischemia time.
Kidneys from 60- or 15-kg pigs were randomized to cold (4°C) or warm (37°C) storage. Local renal graft metabolism was monitored for 24 hours by use of microdialysis and measurements of glycerol, glutamate glucose and lactate.
For all metabolites, there was a significant interaction between time, storage temperature, and kidney size (all P < .0001). For local glycerol and glutamate, a significant increase was observed initially during warm storage, reaching a high steady state level. Glycerol remained low in cold kidneys for 80 minutes, but after 100 minutes there was an ongoing increase (P = .003) with no steady-state maximum level reached during the first 24 hours. The curves in the 2 size groups were parallel (P = .384) with 74% higher glycerol content in large kidneys (P = .005). Glutamate increased in cold kidneys in a similar manner in the 2 size groups (P = .924). Warm storage caused a rapid glucose decline within 60-100 minutes. In cold storage, glucose remained at a steady level until 480 minutes.
Reducing cold ischemia time is of great importance, because concentrations of ischemic metabolites continuously increase in renal grafts. Furthermore, small kidney grafts from growing individuals are more resistant to cold ischemia but more susceptible to warm ischemia. In the setting of donation after circulatory death with prolonged warm ischemia, ongoing catabolism in the potential renal graft may be measured by microdialysis to achieve optimal timing of transplantation.
关于肾移植前热缺血和冷缺血期间移植物的局部代谢情况，人们了解甚少。我们试图描述肾脏移植物在保存期间的局部代谢变化，以了解可接受的缺血时间。
将60千克或15千克猪的肾脏随机分配至冷（4°C）保存或热（37°C）保存。通过微透析以及甘油、谷氨酸、葡萄糖和乳酸的测量，对局部肾脏移植物代谢进行24小时监测。
对于所有代谢物，时间、保存温度和肾脏大小之间存在显著交互作用（所有P <.0001）。对于局部甘油和谷氨酸，热保存开始时观察到显著增加，达到较高的稳定状态水平。冷保存的肾脏中甘油在80分钟内保持较低水平，但100分钟后持续增加（P =.003），在最初24小时内未达到稳定状态的最高水平。两个大小组的曲线平行（P =.384），大肾脏中的甘油含量高74%（P =.005）。两个大小组中冷保存的肾脏中谷氨酸以类似方式增加（P =.924）。热保存导致60 - 100分钟内葡萄糖迅速下降。冷保存时，葡萄糖在480分钟前保持稳定水平。
减少冷缺血时间非常重要，因为肾移植物中缺血代谢物的浓度持续增加。此外，来自生长个体的小肾脏移植物对冷缺血更具抵抗力，但对热缺血更敏感。在循环死亡后捐献且热缺血时间延长的情况下，可通过微透析测量潜在肾移植物中持续的分解代谢，以实现最佳移植时机。
