冷脉冲机器灌注与肾移植中静态冷保存的比较：单中心经验。
Cold Pulsatile Machine Perfusion versus Static Cold Storage in Kidney Transplantation: A Single Centre Experience.
机构信息
Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.
Department of Surgery, Imperial College London, London, UK.
出版信息
Biomed Res Int. 2019 Jan 16;2019:7435248. doi: 10.1155/2019/7435248. eCollection 2019.
INTRODUCTION
We present our experience with hypothermic machine perfusion (HMP) versus cold storage (CS) in relation to kidney transplant outcomes.
METHODS
Retrospective analysis of 33 consecutive HMP kidney transplant outcomes matched with those of 33 cold stored: delayed graft function (DGF), length of hospital stay (LOS), estimated glomerular filtration rate (eGFR), and patient and graft survival were compared. Renal Resistive Indexes (RIs) during HMP in relation to DGF were also analysed.
RESULTS
In the HMP group, mean HMP time was 5.7 ± 3.9 hours with a mean cold ischaemic time (CIT) of 15 ± 5.6 versus 15.1 ± 5.3 hours in the CS group. DGF was lower in the HMP group (p=0.041), and donation after Circulatory Death (DCD) was a predictor for DGF (p<0.01). HMP decreased DGF in DCD grafts (p=0.036). Patient and graft survival were similar, but eGFR at 365 days was higher in the HMP cohort (p<0.001). RIs decreased during HMP (p<0.01); 2-hours RI ≥ 0.45 mmHg/mL/min predicted DGF in DCD kidneys (75% sensitivity, 80% specificity; area under the curve 0.78); 2-hours RI ≥ 0.2 mmHg/ml/min predicted DGF in DBD grafts (sensitivity 100%, specificity 91%; area under the curve 0.87).
CONCLUSION
HMP decreased DGF compared to CS, offering viability assessment pretransplant and improving one-year renal function of the grafts.
介绍
我们介绍了低温机器灌注（HMP）与冷藏（CS）在肾移植结果方面的经验。
方法
回顾性分析了 33 例连续的 HMP 肾移植结果，并与 33 例冷藏的肾移植结果进行了匹配：延迟移植物功能（DGF）、住院时间（LOS）、估计肾小球滤过率（eGFR）、患者和移植物存活率。还分析了 HMP 期间肾阻力指数（RIs）与 DGF 的关系。
结果
在 HMP 组中，HMP 时间的平均值为 5.7±3.9 小时，冷缺血时间（CIT）的平均值为 15±5.6 小时，而 CS 组为 15.1±5.3 小时。HMP 组 DGF 发生率较低（p=0.041），捐献者循环死亡（DCD）是 DGF 的预测因素（p<0.01）。HMP 降低了 DCD 移植物的 DGF（p=0.036）。患者和移植物存活率相似，但 HMP 组在 365 天时的 eGFR 更高（p<0.001）。HMP 期间 RIs 降低（p<0.01）；2 小时 RI≥0.45mmHg/ml/min 预测 DCD 肾脏的 DGF（敏感性 75%，特异性 80%；曲线下面积 0.78）；2 小时 RI≥0.2mmHg/ml/min 预测 DBD 移植物的 DGF（敏感性 100%，特异性 91%；曲线下面积 0.87）。
结论
与 CS 相比，HMP 降低了 DGF，提供了移植前的活力评估，并改善了移植物的一年肾功能。
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