Hameed Ahmer M, Miraziz Ray, Lu David B, Warwick Neil, El-Ayoubi Ali, Burns Heather, Chew Yi Vee, Matthews Ross, O'Grady Greg, Yuen Lawrence, Rogers Natasha, Pleass Henry C, Hawthorne Wayne J
Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.
Centre for Transplant and Renal Research, Westmead Institute for Medical Research, Sydney, New South Wales, Australia.
ANZ J Surg. 2018 May;88(5):E429-E434. doi: 10.1111/ans.14321. Epub 2017 Dec 14.
The ongoing supply-demand gap with respect to donor kidneys for transplantation necessitates the increased use of higher kidney donor profile index and/or donation after circulatory death (DCD) kidneys. Machine perfusion (MP) preservation has become increasingly popular as a means to preserve such organs. Human data regarding normothermic kidney MP (NMP) is in its infancy, and such a system has not been established in the Australasian clinical setting.
Modified cardio-pulmonary bypass technology was utilized to develop a viable NMP kidney perfusion system using a porcine DCD model. System development and optimization occurred in two stages, with system components added in each experiment to identify optimal perfusion conditions.
Device functionality was demonstrated by the successful perfusion of and urine production by, eight porcine kidneys. Urine production diminished in the presence of colloid in the perfusate. Pressure-controlled (compared with flow-controlled) perfusion is preferable as a safe perfusion pressure range can be maintained. More physiologic perfusion conditions are achieved if oxygenation is provided by an oxygen/carbon dioxide mixture compared to 100% oxygen.
A viable and reproducible NMP system was established and tested in porcine kidneys, which was able to simulate graft function extra-corporeally. Further work is required to identify the most optimal perfusion conditions. Prior to its utilization in clinical transplantation, the system should be tested in non-transplanted human kidneys.
移植用供体肾脏目前存在供需缺口，这使得越来越多地使用较高肾脏捐赠者特征指数和/或心脏死亡后捐赠（DCD）肾脏。机器灌注（MP）保存作为一种保存此类器官的方法越来越受欢迎。关于常温肾脏MP（NMP）的人体数据尚处于起步阶段，并且在澳大利亚临床环境中尚未建立这样的系统。
利用改良的体外循环技术，使用猪DCD模型开发一种可行的NMP肾脏灌注系统。系统开发和优化分两个阶段进行，每个实验中添加系统组件以确定最佳灌注条件。
通过成功灌注8个猪肾脏并产生尿液证明了设备的功能。灌注液中存在胶体时尿液生成减少。压力控制（与流量控制相比）灌注更可取，因为可以维持安全的灌注压力范围。与100%氧气相比，如果由氧气/二氧化碳混合物提供氧合，则可实现更接近生理的灌注条件。
在猪肾脏中建立并测试了一种可行且可重复的NMP系统，该系统能够在体外模拟移植物功能。需要进一步开展工作以确定最佳灌注条件。在将该系统用于临床移植之前，应在非移植的人类肾脏中进行测试。
