Dion Marie S, McGregor Thomas B, McAlister Vivian C, Luke Patrick P, Sener Alp
Department of Surgery, Division of Urology, Western University, London, Ontario, Canada.
Department of Surgery, Division of Urology, University of Manitoba, Winnepeg, Manitoba, Canada.
BJU Int. 2015 Dec;116(6):932-7. doi: 10.1111/bju.12960. Epub 2015 May 24.
To evaluate whether hypothermic machine perfusion (HMP) of transplanted kidneys can improve long-term renal allograft function compared with static cold storage (CS).
We evaluated whether graft Doppler ultrasonography resistive indices improved with the use of HMP compared with CS preservation, and examined whether these improvements were predictive of long-term graft function. A total of 30 kidney transplants (15 pairs) were examined. One of the kidney pairs was placed on CS and transplanted first (CS group, n = 15). The other kidney of each pair was placed on HMP and transplanted after the CS group (HMP group, n = 15). Doppler ultrasonography was performed on days 1 and 7 after transplantation and resistive indices were evaluated. The estimated glomerular filtration rate (eGFR) was monitored for 24 months after transplantation.
Despite longer cold ischaemia times, kidneys maintained with HMP had lower resistive indices (P = 0.005) with correspondingly higher eGFR throughout the follow-up. Subgroup analysis showed that the HMP-induced improvement in postoperative eGFR was greatest in kidneys obtained from donation after cardiac death (DCD), even at 2 years after transplantation (P = 0.008).
HMP of transplant kidneys appears to improve vascular resistance after transplantation and has a positive impact on long-term allograft function compared with CS in the population of recipients of DCD kidneys.
评估与静态冷藏（CS）相比，移植肾的低温机器灌注（HMP）是否能改善肾移植长期功能。
我们评估了与CS保存相比，使用HMP时移植肾多普勒超声阻力指数是否改善，并检查这些改善是否能预测移植肾长期功能。共检查了30例肾移植（15对）。其中一对肾进行CS处理并首先移植（CS组，n = 15）。每对中的另一肾进行HMP处理并在CS组之后移植（HMP组，n = 15）。移植后第1天和第7天进行多普勒超声检查并评估阻力指数。移植后监测估计肾小球滤过率（eGFR）24个月。
尽管冷缺血时间更长，但在整个随访期间，采用HMP保存的肾阻力指数较低（P = 0.005），相应地eGFR较高。亚组分析显示，HMP诱导的术后eGFR改善在心脏死亡后捐赠（DCD）获得的肾中最大，甚至在移植后2年时也是如此（P = 0.008）。
在DCD肾受者群体中，与CS相比，移植肾的HMP似乎能改善移植后的血管阻力，并对移植肾长期功能产生积极影响。
