低温脉动机器灌注与冷保存肾脏保存的功能结果：临床试验的系统评价和荟萃分析

Functional Results of Renal Preservation in Hypothermic Pulsatile Machine Perfusion Versus Cold Preservation: Systematic Review and Meta-Analysis of Clinical Trials.

作者信息

Martínez Arcos L, Fabuel Alcañiz J J, Gómez Dos Santos V, Burgos Revilla F J

机构信息

Department of Urology, Ramón and Cajal University Hospital, University of Alcalá, IRYCIS, Madrid, Spain.

出版信息

Transplant Proc. 2018 Jan-Feb;50(1):24-32. doi: 10.1016/j.transproceed.2017.12.005.

DOI:10.1016/j.transproceed.2017.12.005

PMID:29407316

Abstract

BACKGROUND

Hypothermic pulsatile machine perfusion (HPMP) decreases the rate of delayed graft function (DGF) in kidney grafts, compared with cold storage. However, it is not clear its use in the different subgroups of grafts. The objective was to review systematically all studies with better methodologic quality that compare HPMP versus cold storage.

METHODS

A systematic review was performed. The sources were Pubmed, Pubmed Central, Cochrane Library, Clinical Key, and Ovid. All randomized controlled trials that compared HPMP versus cold storage in renal grafts from human donors were considered. Outcomes analyzed were: percentage of DGF, primary nonfunction (PNF), and graft function in each group and for the different types of grafts, brain-death donors (DBDs), and different subgroups of donors after circulatory death (DCDs).

RESULTS

Twelve clinical trials, out of 9,867 titles, were included. HPMP improved DGF overall, as well as in DBDs and DCDs. The relative risks [RRs] were 0.79 (95% CI, 0.71-0.88), 0.85 (95% CI, 0.74-0.98), and 0.75 (95% CI, 0.61-0.92), respectively. There were no differences in PNF overall and for DBDs or DCDs. The RRs were 0.92 (95% CI, 0.73-1.16), 0.78 (95% CI, 0.22-2.73), and 1.13 (95% CI, 0.73-1.77), respectively. However, analysis with the better quality studies, overall RR for PNF was 0.62 (95% CI, 0.39-0.96). There were no differences between the graft function at 3 months after transplantation.

CONCLUSIONS

HPMP moderately improved the DGF results in grafts from cadaver donors of all types. HPMP could improve the PNF in grafts from DBDs, although more clinical trials are needed to prove that.

摘要

背景

与冷藏相比，低温脉动机器灌注（HPMP）可降低肾移植中延迟性移植物功能（DGF）的发生率。然而，其在不同亚组移植物中的应用尚不清楚。目的是系统回顾所有方法学质量较高的比较HPMP与冷藏的研究。

方法

进行了一项系统评价。资料来源为PubMed、PubMed Central、Cochrane图书馆、Clinical Key和Ovid。纳入所有比较HPMP与冷藏在人类供体肾移植中的随机对照试验。分析的结局指标为：每组以及不同类型移植物、脑死亡供体（DBD）和循环死亡后不同亚组供体（DCD）的DGF百分比、原发性无功能（PNF）和移植物功能。

结果

在9867篇文献标题中，纳入了12项临床试验。HPMP总体上改善了DGF，在DBD和DCD中也是如此。相对风险[RR]分别为0.79（95%CI，0.71 - 0.88）、0.85（95%CI，0.74 - 0.98）和0.75（95%CI，0.61 - 0.92）。总体及DBD或DCD的PNF无差异。RR分别为0.92（95%CI，0.73 - 1.16）、0.78（95%CI，0.22 - 2.73）和1.13（95%CI，0.73 - 1.77）。然而，采用质量更好的研究进行分析，PNF的总体RR为0.62（95%CI，0.39 - 0.96）。移植后3个月时移植物功能无差异。