Merion R M, Oh H K, Port F K, Toledo-Pereyra L H, Turcotte J G
Department of Surgery, University of Michigan Medical Center, Ann Arbor 48109-0331.
Transplantation. 1990 Aug;50(2):230-3. doi: 10.1097/00007890-199008000-00011.
A prospective controlled study was carried out in 60 consecutive cadaver renal donors comparing cold storage to pulsatile machine-perfusion preservation. Each donor served as its own control, by allocating one of the kidneys to each of the two preservation methods. There were 51 evaluable pairs of kidneys. Recipient age, panel-reactive antibody level, history of prior renal transplant, and immunosuppressive regimen were similar in the two preservation groups. Almost all recipients were treated with cyclosporine, and over 50% received antilymphoblast globulin. Total cold ischemic time was 1262 +/- 387 min in the machine-perfused group and 1309 +/- 426 min in the cold-storage group (P = NS). Prolonged ischemia (greater than 24 hr) occurred in 31% of machine-perfused and 22% of cold-stored kidneys (P = NS). Post-operative serum creatinine levels at 1, 7, and 30 days posttransplant were similar in both groups. Dialysis requirements were also similar, with 21 recipients of machine-perfused kidneys (41%) requiring at least one dialysis treatment compared to 16 patients (31%) in the cold-stored group (P = NS); the mean number of dialysis treatments required was 3.14 +/- 1.46 and 3.06 +/- 1.29, respectively (P = NS). Long ischemic time (greater than 24 hr) was associated with a higher rate of dialysis requirement in both groups, but in neither case did this achieve statistical significance. The distribution of graft losses within the first 30 days was similar in both groups, and the incidence of preservation-related graft failure was not significantly different. These results demonstrate that, in the cyclosporine era, machine perfusion offers no significant advantages over cold storage for cadaver renal preservation. Because machine perfusion is considerably more expensive and cold storage is simpler and facilitates the logistics of organ sharing, we recommend simple hypothermic storage of renal allografts as the preservation method of choice.
对60例连续的尸体肾供体进行了一项前瞻性对照研究，比较冷保存与搏动式机器灌注保存。通过将每个供体的一个肾脏分配给两种保存方法中的每一种，每个供体作为自身对照。有51对可评估的肾脏。两个保存组的受者年龄、群体反应性抗体水平、既往肾移植史和免疫抑制方案相似。几乎所有受者都接受了环孢素治疗，超过50%的受者接受了抗淋巴细胞球蛋白治疗。机器灌注组的总冷缺血时间为1262±387分钟，冷保存组为1309±426分钟（P=无显著性差异）。31%的机器灌注肾脏和22%的冷保存肾脏发生了长时间缺血（超过24小时）（P=无显著性差异）。移植后1天、7天和30天的术后血清肌酐水平在两组中相似。透析需求也相似，机器灌注肾脏的21名受者（41%）至少需要一次透析治疗，而冷保存组为16名患者（31%）（P=无显著性差异）；所需透析治疗的平均次数分别为3.14±1.46和3.06±1.29（P=无显著性差异）。两组中长时间缺血（超过24小时）均与较高的透析需求率相关，但在两种情况下均未达到统计学显著性。两组在前30天内移植肾丢失的分布相似，与保存相关的移植肾失败发生率无显著差异。这些结果表明，在环孢素时代，对于尸体肾保存，机器灌注相对于冷保存没有显著优势。由于机器灌注成本高得多，而冷保存更简单且便于器官共享的后勤工作，我们建议将同种异体肾移植的简单低温保存作为首选的保存方法。
