Zhong Zibiao, Lan Jia'nan, Ye Shaojun, Liu Zhongzhong, Fan Lin, Zhang Yang, Fu Zhen, Qiao Bingbing, Shiu-Chung Ko Dicken, Wang Yanfeng, Ye Qifa
Wuhan University, Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation, Wuhan, Hubei.
Research Center of National Health Ministry on Transplantation Medicine Engineering and Technology, The 3rd Xiangya Hospital of Central South University, Changsha, China.
Artif Organs. 2017 Jul;41(7):647-653. doi: 10.1111/aor.12828.
Organ shortage has led to an increased use of kidneys from cardiac death donors (DCDs), but controversies about the methods of organ preservation still exist. This study aims to compare the effect of machine perfusion (MP) and cold storage (CS) in protecting kidneys harvested from DCDs. 141 kidney pairs from DCDs between July 2010 and July 2015 were included in this randomized controlled study. One kidney from each donor was randomly assigned to MP and the contralateral kidney was assigned to CS. Delayed graft function (DGF) rate, resistance index of renal arteries, early renal function, and survival rates were used to estimate the effect of preservation. The results showed that MP decreased the rate of DGF from 33.3 to 22.0% (P = 0.033). Ultrasound of the kidneys within 48 h after transplantation showed that the resistance index of renal main artery (0.673 ± 0.063 vs. 0.793 ± 0.124, P < 0.001), sub segmental artery (0.66 ± 0.062 vs. 0.764 ± 0.077, P < 0.001) and interlobular artery (0.648 ± 0.056 vs. 0.745 ± 0.111, P = 0.023) were all significantly lower in the MP group than those in the CS group. Furthermore, compared to the CS group, in the first 7 days following transplantation, the median urine volume was significantly higher (4080 mL vs. 3000 mL, P = 0.047) in kidneys sustained using MP and the median serum creatinine was remarkably lower (180 µmol/L vs. 390 µmol/L, P = 0.024). More importantly, MP group had higher 1- and 3-year graft survival rates (98% vs. 93%, P = 0.026; 93% vs. 82%, P = 0.036, respectively). Hypothermic MP improved the outcomes of DCD kidney transplantation.
器官短缺导致心脏死亡供体（DCD）肾脏的使用增加，但关于器官保存方法的争议仍然存在。本研究旨在比较机器灌注（MP）和冷藏（CS）对保护从DCD获取的肾脏的效果。本随机对照研究纳入了2010年7月至2015年7月期间141对DCD肾脏。每个供体的一个肾脏被随机分配至MP组，对侧肾脏被分配至CS组。采用移植肾功能延迟恢复（DGF）率、肾动脉阻力指数、早期肾功能和生存率来评估保存效果。结果显示，MP使DGF率从33.3%降至22.0%（P = 0.033）。移植后48小时内的肾脏超声检查显示，MP组肾主动脉阻力指数（0.673±0.063对0.793±0.124，P < 0.001）、亚段动脉阻力指数（0.66±0.062对0.764±0.077，P < 0.001）和小叶间动脉阻力指数（0.648±0.056对0.745±0.111，P = 0.023）均显著低于CS组。此外，与CS组相比，移植后的前7天，采用MP保存的肾脏中位尿量显著更高（4080 mL对3000 mL，P = 0.047），中位血清肌酐显著更低（180 µmol/L对390 µmol/L，P = 0.024）。更重要的是，MP组1年和3年移植肾生存率更高（分别为98%对93%，P = 0.026；93%对82%，P = 0.036）。低温MP改善了DCD肾移植的结局。
