Maessen J G, van der Vusse G J, Vork M, Kootstra G
Department of Surgery, University of Limburg, Maastricht, The Netherlands.
Transplantation. 1989 Mar;47(3):409-14. doi: 10.1097/00007890-198903000-00001.
The effect of simple cold storage on ice with or without preceding warm ischemic injury on the energy metabolism and posttransplant viability of canine kidneys was examined in the present study. In addition, we investigated the possible beneficial effect of an intermediate normothermic perfusion half-way through the storage period on the preservation of ischemically injured kidneys. Thirty mongrel dogs were allocated to 5 experimental groups. In groups I and II kidneys were simply stored on ice for 24 and 48 hr, respectively. In groups III and IV kidneys were additionally subjected to 30 min warm ischemia before storage. In group 5 kidneys were treated as in group IV, but halfway through the storage period an intermediate normothermic ex-vivo perfusion was performed. The effect of these procedures on renal viability was tested by autologous reimplantation of the kidneys. During implantation the contralateral kidney was immediately removed. In group I all animals survived, whereas in group IV none of the animals survived. In groups II, III, and V, 2 of 6, 1 of 6, and 3 of 6 animals survived, respectively. The relationship, if any, between poststorage renal viability and the tissue levels of adenine nucleotides, guanine nucleotides, IMP, and purine degradation products was assessed by measuring the content of these metabolites in tissue specimen of the renal cortex, on which biopsies were done at various intervals during the experimental procedures. After an initial drop of about 30% in the content of adenine and guanine nucleotides and an increase in IMP, these values remained constant during 48 hr of cold storage. In contrast to kidneys stored for 24 hr, reimplantation of kidneys stored for 48 hr resulted in a significant decrease of adenine nucleotides following 60 min of in vivo reperfusion. Warm ischemia for 30 min prior to cold storage lead to lower initial nucleotide levels at the start of the storage period. During the first 24 hr nucleotide levels did not change, but a further decrease was observed during the following 24 hr of storage. Reimplantation after 24 hr of storage resulted in an additional decrease in the content of nucleotides. This poststorage decrease was absent after 48 hr of cold storage. Intermediate normothermic perfusion halfway through the storage for 48 hr significantly prevented the drop in the nucleotide content observed during the last 24 hr of storage in the corresponding control group. This nucleotide-sparing effect did not increase the level of nucleotides at the end of 60 min of reperfusion following reimplantation.(ABSTRACT TRUNCATED AT 400 WORDS)
本研究检测了单纯冷藏对伴有或不伴有先前热缺血损伤的犬肾能量代谢及移植后存活能力的影响。此外，我们还研究了在保存期中间进行一次常温灌注对缺血损伤肾脏保存的可能有益作用。30只杂种犬被分为5个实验组。在I组和II组中，肾脏分别单纯冷藏24小时和48小时。在III组和IV组中，肾脏在冷藏前还经历了30分钟的热缺血。在第5组中，肾脏的处理与IV组相同，但在保存期中间进行了一次常温体外灌注。通过自体肾再植检测这些操作对肾脏存活能力的影响。再植过程中，对侧肾脏立即切除。I组所有动物存活，而IV组无动物存活。在II组、III组和V组中，分别有6只中的2只、6只中的1只和6只中的3只动物存活。通过测量肾皮质组织标本中这些代谢物的含量，评估保存后肾脏存活能力与腺嘌呤核苷酸、鸟嘌呤核苷酸、肌苷酸和嘌呤降解产物组织水平之间的关系，在实验过程中的不同时间间隔对肾皮质进行活检获取组织标本。腺嘌呤和鸟嘌呤核苷酸含量最初下降约30%，肌苷酸增加，之后在48小时冷藏期间这些值保持稳定。与冷藏24小时的肾脏相比，冷藏48小时的肾脏再植后，体内再灌注60分钟后腺嘌呤核苷酸显著减少。冷藏前热缺血30分钟导致保存期开始时核苷酸初始水平较低。在最初24小时核苷酸水平未变化，但在随后24小时的保存期内观察到进一步下降。冷藏24小时后再植导致核苷酸含量进一步减少。冷藏48小时后不存在这种保存后减少的情况。在48小时保存期中间进行常温灌注显著防止了相应对照组在保存期最后24小时观察到的核苷酸含量下降。这种核苷酸保护作用并未在再植后60分钟再灌注结束时提高核苷酸水平。（摘要截选至400字）
