a Department of Surgical Research General, Visceral and Transplantation Surgery , University Hospital Essen, University Duisburg-Essen , Essen , Germany.
Scand J Clin Lab Invest. 2018 Feb-Apr;78(1-2):131-135. doi: 10.1080/00365513.2017.1422539. Epub 2018 Jan 4.
Within the scope of transplantation research, ex vivo kidney perfusion has been proven an attractive model to study ischemia-reperfusion and preservation injury. Renal perfusion techniques also occupy scientists with the aim to optimize organ reconditioning and preparation prior to transplantation. This study investigated the influence of a pulsatile perfusion pattern that brings flow conditions closer to physiological situations, on renal perfusion characteristic and kidney function in the isolated perfused kidney. Kidneys were perfused via a roller pump at constant pressure set to 90 mmHg, or with addition of pulsatile pressure peaks (90/70 mmHg; 60/min) using an adjustable positive displacement pump. It was found that pulsatile pressure significantly enhanced renal flow rates as compared to non-pulsatile perfusion mode, especially after preceding preservation of the kidney by static cold storage. The improved vascular conductivity went along with a notable improvement of clearance of creatinine, sodium reabsorption and reduced tubular cell injury (Loss of fatty acid binding protein). The better vascular conductance upon pulsatile perfusion could be attributed to improved endothelial release of nitic oxide and reduced secretion of endothelin-1 into the perfusate. It is concluded, that pulsatile perfusion mode should be preferred in isolated kidney perfusion as resulting in better preservation/recovery of renal perfusion and function.
在移植研究范围内，离体肾脏灌注已被证明是一种有吸引力的模型，可用于研究缺血再灌注和保存损伤。肾脏灌注技术也吸引着科学家们，旨在优化器官再调节和移植前的准备。本研究调查了更接近生理情况的脉动灌注模式对离体灌注肾脏的肾脏灌注特性和肾功能的影响。肾脏通过滚压泵以设定为 90mmHg 的恒压进行灌注，或使用可调式正排量泵以脉动压力峰值（90/70mmHg；60/min）进行灌注。结果发现，与非脉动灌注模式相比，脉动压力显著提高了肾脏的血流速度，尤其是在肾脏经过静态冷保存保存后。血管通透性的提高伴随着肌酐清除率的显著提高、钠重吸收减少和肾小管细胞损伤减轻（脂肪酸结合蛋白丢失）。脉动灌注时更好的血管传导性可归因于内皮细胞一氧化氮释放的改善和内皮素-1分泌到灌流液中的减少。因此，脉动灌注模式应在离体肾脏灌注中优先选择，因为它可以更好地保存/恢复肾脏的灌注和功能。
