Tedesco-Silva Helio, Mello Offerni Juliano Chrystian, Ayres Carneiro Vanessa, Ivani de Paula Mayara, Neto Elias David, Brambate Carvalhinho Lemos Francine, Requião Moura Lúcio Roberto, Pacheco E Silva Filho Alvaro, de Morais Cunha Mirian de Fátima, Francisco da Silva Erica, Miorin Luiz Antonio, Demetrio Daniela Priscila, Luconi Paulo Sérgio, da Silva Luconi Waldere Tania, Bobbio Savina Adriana, Kuschnaroff Liz Milstein, Noronha Irene Lourdes, Braga Sibele Lessa, Barsante Renata Cristina, Mendes Moreira João Cezar, Fernandes-Charpiot Ida Maria Maximina, Abbud-Filho Mario, Modelli de Andrade Luis Gustavo, Dalsoglio Garcia Paula, Tanajura Santamaria Saber Luciana, Fernandes Laurindo Alan, Chocair Pedro Renato, Cuvello Neto Américo Lourenço, Zanocco Juliana Aparecida, Duboc de Almeida Soares Filho Antonio Jose, Ferreira Aguiar Wilson, Medina Pestana Jose
Hospital do Rim, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
Organização de Procura de Orgãos, Escola Paulista de Medicina, São Paulo, SP, Brazil.
Transplant Direct. 2017 Apr 18;3(5):e155. doi: 10.1097/TXD.0000000000000672. eCollection 2017 May.
This study compared the use of static cold storage versus continuous hypothermic machine perfusion in a cohort of kidney transplant recipients at high risk for delayed graft function (DGF).
In this national, multicenter, and controlled trial, 80 pairs of kidneys recovered from brain-dead deceased donors were randomized to cold storage or machine perfusion, transplanted, and followed up for 12 months. The primary endpoint was the incidence of DGF. Secondary endpoints included the duration of DGF, hospital stay, primary nonfunction, estimated glomerular filtration rate, acute rejection, and allograft and patient survivals.
Mean cold ischemia time was high but not different between the 2 groups (25.6 ± 6.6 hours vs 25.05 ± 6.3 hours, 0.937). The incidence of DGF was lower in the machine perfusion compared with cold storage group (61% vs. 45%, = 0.031). Machine perfusion was independently associated with a reduced risk of DGF (odds ratio, 0.49; 95% confidence interval, 0.26-0.95). Mean estimated glomerular filtration rate tended to be higher at day 28 (40.6 ± 19.9 mL/min per 1.73 m vs 49.0 ± 26.9 mL/min per 1.73 m; = 0.262) and 1 year (48.3 ± 19.8 mL/min per 1.73 m vs 54.4 ± 28.6 mL/min per 1.73 m; = 0.201) in the machine perfusion group. No differences in the incidence of acute rejection, primary nonfunction (0% vs 2.5%), graft loss (7.5% vs 10%), or death (8.8% vs 6.3%) were observed.
In this cohort of recipients of deceased donor kidneys with high mean cold ischemia time and high incidence of DGF, the use of continuous machine perfusion was associated with a reduced risk of DGF compared with the traditional cold storage preservation method.
本研究比较了静态冷藏与持续低温机器灌注在一组移植肾功能延迟（DGF）高风险肾移植受者中的应用情况。
在这项全国性、多中心对照试验中，将从脑死亡供体获取的80对肾脏随机分为冷藏组或机器灌注组，进行移植，并随访12个月。主要终点是DGF的发生率。次要终点包括DGF持续时间、住院时间、原发性无功能、估计肾小球滤过率、急性排斥反应以及移植肾和患者存活率。
平均冷缺血时间较长，但两组间无差异（25.6±6.6小时对25.05±6.3小时，P=0.937）。与冷藏组相比，机器灌注组DGF的发生率较低（61%对45%，P=0.031）。机器灌注与DGF风险降低独立相关（优势比，0.49；95%置信区间，0.26-0.95）。在第28天（每1.73平方米40.6±19.9毫升/分钟对49.0±26.9毫升/分钟；P=0.262）和1年时（每1.73平方米48.3±19.8毫升/分钟对54.4±28.6毫升/分钟；P=0.201），机器灌注组的平均估计肾小球滤过率有升高趋势。在急性排斥反应发生率、原发性无功能（0%对2.5%）、移植肾丢失（7.5%对10%）或死亡（8.8%对6.3%）方面未观察到差异。
在这组平均冷缺血时间长且DGF发生率高的死亡供体肾移植受者中，与传统冷藏保存方法相比，持续机器灌注与DGF风险降低相关。
