Department of Surgery, University of Cambridge, Cambridge, UK.
Freeman Hospital, Newcastle University, Newcastle upon Tyne, UK.
Br J Surg. 2018 Mar;105(4):388-394. doi: 10.1002/bjs.10733. Epub 2017 Dec 6.
A significant proportion of donation after circulatory death (DCD) kidneys are declined for transplantation because of concerns over their quality. Ex vivo normothermic machine perfusion (NMP) provides a unique opportunity to assess the quality of a kidney and determine its suitability for transplantation.
In phase 1 of this study, declined human DCD kidneys underwent NMP assessment for 60 min. Kidneys were graded 1-5 using a quality assessment score (QAS) based on macroscopic perfusion, renal blood flow and urine output during NMP. In phase 2 of the study, declined DCD kidneys were assessed by NMP with an intention to transplant them.
In phase 1, 18 of 42 DCD kidneys were declined owing to poor in situ perfusion. After NMP, 28 kidneys had a QAS of 1-3, and were considered suitable for transplantation. In phase 2, ten of 55 declined DCD kidneys underwent assessment by NMP. Eight kidneys had been declined because of poor in situ flushing in the donor and five of these were transplanted successfully. Four of the five kidneys had initial graft function.
NMP technology can be used to increase the number of DCD kidney transplants by assessing their quality before transplantation.
由于对其质量的担忧,相当一部分心脏死亡后捐献(DCD)肾脏因不符合移植标准而被拒绝。体外常温机器灌注(NMP)为评估肾脏质量并确定其是否适合移植提供了独特的机会。
在这项研究的第 1 阶段,对被拒绝的人类 DCD 肾脏进行了 60 分钟的 NMP 评估。使用基于 NMP 期间宏观灌注、肾血流量和尿量的质量评估评分(QAS)对肾脏进行 1-5 级评分。在研究的第 2 阶段,对被拒绝的 DCD 肾脏进行了 NMP 评估,目的是移植它们。
在第 1 阶段,由于原位灌注不良,42 个 DCD 肾脏中有 18 个被拒绝。在 NMP 后,28 个肾脏的 QAS 为 1-3,被认为适合移植。在第 2 阶段,对 55 个被拒绝的 DCD 肾脏中的 10 个进行了 NMP 评估。有 8 个肾脏因供体原位冲洗不良而被拒绝,其中 5 个成功移植。这 5 个肾脏中有 4 个有初始移植物功能。
NMP 技术可用于在移植前评估其质量,从而增加 DCD 肾脏移植的数量。