Ruiz-Hernández M, Gómez-Dos Santos V, Díaz-Pérez D, Fernández-Alcalde Á, Hevia-Palacios V, Álvarez-Rodríguez S, Díez-Nicolás V, Elías-Triviño S, Burgos-Revilla F J
Urology Department, Ramón y Cajal University Hospital, Surgical Urology and Transplantation Research Group, IRYCIS, Alcalá University, Madrid, Spain.
Urology Department, Ramón y Cajal University Hospital, Surgical Urology and Transplantation Research Group, IRYCIS, Alcalá University, Madrid, Spain.
Transplant Proc. 2019 Mar;51(2):303-306. doi: 10.1016/j.transproceed.2018.09.020. Epub 2018 Sep 18.
Hypothermic machine perfusion (HMP) decreases delayed graft function (DGF) and improves 1-year graft survival in expanded criteria donors (ECDs). Time of HMP could be associated with incidence of DGF.
To analyze functional outcomes of ECD grafts preserved totally (local grafts) or partially (imported grafts) with HMP.
We analyzed prospectively collected data from a cohort of first ECD graft receptors, with a minimum follow-up of 6 months. A total of 119 imported and 74 local grafts were included. Local ECD kidneys were preserved with HMP after retrieval. Imported ECD kidneys were preserved with simple cold storage and HMP. Vascular thrombosis, acute rejection, DGF, 1-year glomerular filtration rate, and 1-year graft survival were assessed. Univariate and estimative multivariate logistic regression was applied for analysis of DGF. A Cox proportional hazards model was applied to estimate graft survival.
DGF occurred in 14 recipients of local grafts and in 33 recipients of imported grafts (28.0 vs 18.1%, P = .13); 1-year graft survival was better in the group of local grafts (80.3 vs 91.9%, P = .03). No differences in vascular thrombosis (5.9 vs 5.4%, P = .88), acute rejection (12.3 vs 9.8%, P = .91), or 1-year glomerular filtration rate (41.2 vs 40.5 mL/m/1.73m, P = .87) were observed. In multivariate analysis, adjusted odds ratio for DGF was 1.20 (P = .79) and adjusted hazard ratio for graft survival was 1.93 (P = .31).
There is a trend that complete HMP reduces the risk of DGF and improves 1-year graft survival in ECD kidneys.
低温机器灌注（HMP）可降低扩大标准供体（ECD）移植肾的延迟性移植肾功能不全（DGF）发生率，并提高其1年移植肾存活率。HMP的时间可能与DGF的发生率相关。
分析采用HMP完全保存（本地移植肾）或部分保存（进口移植肾）的ECD移植肾的功能结局。
我们前瞻性分析了一组首次接受ECD移植肾的受者的数据，随访时间至少6个月。共纳入119例进口移植肾和74例本地移植肾。本地ECD肾在切取后采用HMP保存。进口ECD肾采用单纯冷藏加HMP保存。评估血管血栓形成、急性排斥反应、DGF、1年肾小球滤过率和1年移植肾存活率。采用单因素和估计多因素逻辑回归分析DGF。应用Cox比例风险模型估计移植肾存活率。
本地移植肾组有14例受者发生DGF，进口移植肾组有33例受者发生DGF（28.0%对18.1%；P = 0.13）；本地移植肾组的1年移植肾存活率更高（80.3%对91.9%；P = 0.03）。未观察到血管血栓形成（5.9%对5.4%；P = 0.88）、急性排斥反应（12.3%对9.8%；P = 0.91）或1年肾小球滤过率（41.2对40.5 mL/m/1.73m；P = 0.87）存在差异。在多因素分析中，DGF的调整优势比为1.20（P = 0.79），移植肾存活的调整风险比为1.93（P = 0.31）。
有趋势表明，完全HMP可降低ECD肾发生DGF 的风险并提高其1年移植肾存活率。
