Agence de la Biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France.
CHU Nantes, Nantes, France.
Clin Transplant. 2019 May;33(5):e13536. doi: 10.1111/ctr.13536. Epub 2019 Apr 10.
In 2012, an expert working group from the French Transplant Health Authority recommended the use of hypothermic machine perfusion (HMP) to improve kidney preservation and transplant outcomes from expanded criteria donors, deceased after brain death. This study compares HMP and cold storage (CS) effects on delayed graft function (DGF) and transplant outcomes. We identified 4,316 kidney transplants from expanded criteria donors (2011-2014) in France through the French Transplant Registry. DGF occurrence was analyzed with a logistic regression, excluding preemptive transplants. One-year graft failure was analyzed with a Cox regression. A subpopulation of 66 paired kidneys was identified: one preserved by HMP and the other by CS from the same donor. Kidneys preserved by HMP (801) vs CS (3515) were associated with more frequent recipient comorbidities and older donors and recipients. HMP had a protective effect against DGF (24% in HMP group and 38% in CS group, OR = 0.49 [0.40-0.60]). Results were similar in the paired kidneys (OR = 0.23 [0.04-0.57]). HMP use decreased risk for 1-year graft failure (HR = 0.77 [0.60-0.99]). Initial hospital stays were shorter in the HMP group (P < 0.001). Our results confirm the reduction in DGF occurrence among expanded criteria donors kidneys preserved by HMP.
2012 年，法国移植健康管理局的一个专家工作组建议使用低温机器灌注（HMP）来改善扩大标准供体的肾脏保存和移植效果，这些供体在脑死亡后死亡。本研究比较了 HMP 和低温保存（CS）对延迟移植物功能障碍（DGF）和移植效果的影响。我们通过法国移植登记处确定了法国 4316 例来自扩大标准供体的肾移植（2011-2014 年）。通过逻辑回归排除抢先移植，分析 DGF 发生情况。采用 Cox 回归分析 1 年移植物失败情况。从同一供体中确定了 66 对配对肾脏的亚组：一个用 HMP 保存，另一个用 CS 保存。用 HMP（801 个）保存的肾脏与用 CS（3515 个）保存的肾脏相比，受体合并症更多，供体和受体年龄更大。HMP 对 DGF 有保护作用（HMP 组为 24%，CS 组为 38%，OR=0.49[0.40-0.60]）。配对肾脏的结果相似（OR=0.23[0.04-0.57]）。HMP 的使用降低了 1 年移植物失败的风险（HR=0.77[0.60-0.99]）。HMP 组的初始住院时间更短（P<0.001）。我们的结果证实，HMP 保存的扩大标准供体肾脏的 DGF 发生率降低。
