Department of Renal Surgery, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.
Institute of Metabolism and Systems Research, School of Medical and Dental Science, University of Birmingham, Birmingham, UK.
Am J Transplant. 2018 Jun;18(6):1408-1414. doi: 10.1111/ajt.14587. Epub 2017 Dec 15.
Evidence is currently lacking regarding the outcomes of kidneys undergoing hypothermic machine perfusion (HMP) in patients in the United Kingdom. Using the National Health Service Blood and Transplant database, the authors compared outcomes for recipients of single-organ donation after circulatory death (DCD) kidneys preserved with HMP with those preserved using only static cold storage (SCS). Between 2007 and 2015, HMP was used in 19.1% (864/4,529) of kidneys. Rates of delayed graft function (DGF) were significantly lower in organs preserved with HMP than for organs preserved with SCS (34.2% vs 42.0%, P < .001), despite a slightly longer cold ischemic time (median: 14.8 vs 14.1 hours, P < .001). Multivariable analysis found the effect of preservation modality to remain significant, with HMP organs having a significantly lower rate of DGF (odds ratio 0.65, 95% confidence interval 0.53-0.80, P < .001) and significantly shorter times to DGF resolution (average: 6.1 vs 7.4 days, P = .003) than SCS organs. The patient (P = .313) and graft (P = .263) survival rates were similar in the 2 preservation groups. HMP was associated with a marginal functional benefit in 1-year creatinine values (P = .044), with adjusted averages of 1.36 mg/dL (HMP) versus 1.40 mg/dL (SCS). This study supports the use of HMP and aids decision-making over its instigation, which may improve short-term patient outcomes.
目前，英国患者的低温机器灌注（HMP）肾脏的结果缺乏证据。作者利用国家卫生服务部血液和移植数据库，比较了使用 HMP 保存的循环死亡（DCD）供体单器官接受者与仅使用静态冷藏（SCS）保存的接受者的结果。在 2007 年至 2015 年期间，HMP 用于 19.1%（4529 例中的 864 例）的肾脏。与 SCS 保存的器官相比，HMP 保存的器官的延迟移植物功能障碍（DGF）发生率明显较低（分别为 34.2%和 42.0%，P<.001），尽管冷缺血时间略长（中位数：14.8 小时对 14.1 小时，P<.001）。多变量分析发现保存方式的影响仍然显著，HMP 器官的 DGF 发生率显著较低（比值比 0.65，95%置信区间 0.53-0.80，P<.001），DGF 缓解时间也明显较短（平均：6.1 天对 7.4 天，P=.003）。在 2 种保存组中，患者（P=.313）和移植物（P=.263）的存活率相似。HMP 与 1 年肌酐值的边缘功能获益相关（P=.044），调整后的平均值为 1.36mg/dL（HMP）与 1.40mg/dL（SCS）。本研究支持 HMP 的使用，并有助于在启动 HMP 时做出决策，这可能会改善短期患者结局。
