Matos Ana Cristina C, Requiao Moura Lúcio Roberto, Borrelli Milton, Nogueira Mario, Clarizia Gabriela, Ongaro Paula, Durão Marcelino Souza, Pacheco-Silva Alvaro
Renal Transplantation Division, Hospital Israelita Albert Einstein, São Paulo, Brazil.
Department of Medicine/Nephrology, Universidade Federal de São Paulo, São Paulo, Brazil.
Clin Transplant. 2018 Jan;32(1). doi: 10.1111/ctr.13130. Epub 2017 Nov 26.
Delayed graft function (DGF) is very high in our center (70%-80%), and we usually receive a kidney for transplant after more than 22 hours of static cold ischemia time (CIT). Also, there is an inadequate care of the donors, contributing to a high rate of DGF. We decided to test whether machine perfusion (MP) after a CIT improved the outcome of our transplant patients. We analyzed the incidence of DGF, its duration, and the length of hospital stay (LOS) in patients who received a kidney preserved with MP after a CIT (hybrid perfusion-HP). We included 54 deceased donors kidneys preserved with HP transplanted from Feb/13 to Jul/14, and compared them to 101 kidney transplants preserved by static cold storage (CS) from Nov/08 to May/12. The median pumping time was 11 hours. DGF incidence was 61.1% vs 79.2% (P = .02), median DGF duration was 5 vs 11 days (P < .001), and median LOS was 13 vs 18 days (P < .011), for the HP compared to CS group. The observed reduction of DGF with machine perfusion did not occur in donors over 50 years old. In the multivariate analysis, risk factors for DGF, adjusted for CIT, were donor age (OR, 1.04; P = .005) and the absence of use of MP (OR, 1.54; P = .051). In conclusion, the use of HP contributed to faster recovery of renal function and to a shorter length of hospital stay.
延迟移植肾功能（DGF）在我们中心的发生率非常高（70%-80%），并且我们通常在静态冷缺血时间（CIT）超过22小时后接收用于移植的肾脏。此外，对供体的护理不足，导致DGF发生率很高。我们决定测试CIT后进行机器灌注（MP）是否能改善我们移植患者的结局。我们分析了接受CIT后用MP保存肾脏的患者（混合灌注-HP）中DGF的发生率、持续时间以及住院时间（LOS）。我们纳入了2013年2月至2014年7月间用HP保存的54例来自脑死亡供体的肾脏移植病例，并将其与2008年11月至2012年5月间用静态冷藏（CS）保存的101例肾脏移植病例进行比较。中位灌注时间为11小时。与CS组相比，HP组的DGF发生率为61.1% 对79.2%（P = 0.02），DGF中位持续时间为5天对11天（P < 0.001），中位LOS为13天对18天（P < 0.011）。在50岁以上的供体中，未观察到机器灌注使DGF减少。在多变量分析中，校正CIT后，DGF的危险因素为供体年龄（OR，1.04；P = 0.005）和未使用MP（OR，1.54；P = 0.051）。总之，使用HP有助于肾功能更快恢复和缩短住院时间。
