Gallinat Anja, Efferz Patrik, Paul Andreas, Minor Thomas
Clinic of General, Visceral and Transplantation Surgery, University Hospital of Essen, Essen, Germany.
Transpl Int. 2014 Nov;27(11):1214-9. doi: 10.1111/tri.12393. Epub 2014 Aug 20.
In-house machine perfusion after cold storage (hypothermic reconditioning) has been proposed as convenient tool to improve kidney graft function. This study investigated the role of machine perfusion duration for early reperfusion parameters in porcine kidneys. Kidney function after cold preservation (4 °C, 18 h) and subsequent reconditioning by one or 4 h of pulsatile, nonoxygenated hypothermic machine perfusion (HMP) was studied in an isolated kidney perfusion model in pigs (n = 6, respectively) and compared with simply cold-stored grafts (CS). Compared with CS alone, one or 4 h of subsequent HMP similarly and significantly improved renal flow and kidney function (clearance and sodium reabsorption) upon warm reperfusion, along with reduced perfusate concentrations of endothelin-1 and increased vascular release of nitric oxide. Molecular effects of HMP comprised a significant (vs CS) mRNA increase in the endothelial transcription factor KLF2 and lower expression of endothelin that were observed already at the end of one-hour HMP after CS. Reconditioning of cold-stored kidneys is possible, even if clinical logistics only permit one hour of therapy, while limited extension of the overall storage time by in-house machine perfusion might also allow for postponing of transplantation from night to early day work.
冷保存后（低温修复）的原位机器灌注已被提议作为改善肾移植功能的便捷工具。本研究调查了机器灌注持续时间对猪肾早期再灌注参数的作用。在猪的离体肾灌注模型中（每组n = 6），研究了冷保存（4°C，18小时）后，通过1小时或4小时的搏动性、非氧合低温机器灌注（HMP）进行后续修复后的肾功能，并与单纯冷保存的移植物（CS）进行比较。与单独的CS相比，后续1小时或4小时的HMP在温暖再灌注时同样显著改善了肾血流和肾功能（清除率和钠重吸收），同时降低了灌注液中内皮素-1的浓度，并增加了一氧化氮的血管释放。HMP的分子效应包括内皮转录因子KLF2的mRNA显著增加（与CS相比），以及内皮素表达降低，这些在冷保存后1小时HMP结束时就已观察到。即使临床后勤仅允许1小时的治疗，冷保存肾的修复也是可行的，而通过原位机器灌注有限地延长总保存时间也可能允许将移植从夜间推迟到白天早些时候进行。
