Department of Surgery, Division of Transplant Surgery, Albert Einstein Medical Center, Philadelphia, PA, USA.
Department of Surgery, Division of Transplant Surgery, Albert Einstein Medical Center, Philadelphia, PA, USA.
Int J Surg. 2014;12(6):551-6. doi: 10.1016/j.ijsu.2014.04.002. Epub 2014 Apr 13.
Warm ischemic time (WIT) in kidney transplantation has significant effects on graft survival, function, and postoperative morbidity. We utilized the Ice Bag Technique (IBT) to determine if eliminating WIT would decrease the incidence and length of delayed graft function (DGF) in our cohort.
We conducted a prospective study of 150 kidney transplants. We compared the elimination of WIT with IBT to traditional methods. Data was analyzed using non-parametric statistical tests.
66 of the 134 patients underwent transplantation using IBT. 28 right kidneys, 34 left kidneys, and 4 dual kidneys were implanted successfully. Patients with a body mass index (BMI) as high as 41 were transplanted. Kidneys with up to three arteries and two veins, and kidneys up to 15.5 by 9 cm in size were safely transplanted into either iliac fossa. Despite the complete elimination of WIT, there was no difference in DGF, length of DGF, length of stay graft rejection, graft survival, patient survival, or wound or urologic complications between groups (p > 0.05).
The elimination of warm ischemic time using the IBT does not appear to reduce the incidence or length of DGF in this cohort. The technique may be useful for cases with prolonged anastomosis time (AT), but further studies with larger cohorts are required to determine whether it decreases DGF.
肾移植过程中的热缺血时间（WIT）对移植物的存活率、功能和术后发病率有显著影响。我们采用冰袋技术（IBT）来确定是否可以消除 WIT，从而降低我们队列中延迟性肾功能不全（DGF）的发生率和持续时间。
我们进行了一项前瞻性研究，共纳入 150 例肾移植患者。我们比较了消除 WIT 与 IBT 与传统方法的效果。使用非参数统计检验对数据进行分析。
在 134 例接受移植的患者中，有 66 例采用了 IBT。成功植入 28 个右侧肾脏、34 个左侧肾脏和 4 个双肾。BMI 高达 41 的患者也接受了移植。接受移植的肾脏动脉多达 3 根、静脉多达 2 根，大小可达 15.5×9cm。尽管完全消除了 WIT，但两组间在 DGF 的发生率、DGF 的持续时间、移植排斥反应的持续时间、移植物存活率、患者存活率或伤口或泌尿系统并发症方面均无差异（p＞0.05）。
在本队列中，采用 IBT 消除热缺血时间似乎不会降低 DGF 的发生率或持续时间。该技术可能对吻合时间较长的病例有用，但需要进一步研究以确定其是否可以降低 DGF 的发生率。
