Darius Tom, Vergauwen Martial, Mueller Matteo, Aydin Selda, Dutkowski Philipp, Gianello Pierre, Mourad Michel
Department of Surgery, Surgery and Abdominal Transplant Unit, University Clinics Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Chirurgie Expérimentale et Transplantation, Université Catholique de Louvain, Brussels, Belgium.
Transplant Direct. 2020 Jun 11;6(7):e571. doi: 10.1097/TXD.0000000000001016. eCollection 2020 Jul.
The aim of this feasibility study was to determine an alternative oxygenation technique (easy, cheap, and compatible with air transport) for membrane oxygenation during hypothermic machine perfusion (HMP) to improve early graft function in a porcine ischemia-reperfusion autotransplant model.
The left kidney of a ±40- kg pig was exposed to 30 minutes of warm ischemia before 22 hours of preservation and autotransplantation. In the experimental group, oxygenation of the perfusate during HMP was obtained by direct bubble and 30-minute surface oxygenation at start and 1-hour end ischemic (n = 4) and outcome measures compared with historical HMP without active oxygenation (n = 6), 22-hour continuous oxygenated HMP (HMPO) (n = 8), and 2-hour HMPO + 20-hour HMP (n = 6) using membrane oxygenation in both historical oxygenated control groups.
Brief bubble and 30-minute surface oxygenation of the perfusate effectively maintained supraphysiological Po levels during the first 2 hours of HMP with improved flow dynamics. Although the metabolic profile of the perfusate (ie, flavin mononucleotide) and tissue (ie, glutamate, ATP) after brief O uploading at the start of HMP seemed to be slightly better with the use of a membrane oxygenator compared with bubble and interrupted surface oxygenation, both techniques yielded similar, superior early graft function when compared with HMP without active oxygenation.
The data presented in this feasibility study support the conclusion that brief bubble and intermittent surface oxygenation could be an alternative oxygenation technique during HMP to achieve an improved kidney graft function compared with HMP without active oxygenation and similar functional outcome when compared with membrane HMPO.
本可行性研究的目的是确定一种用于低温机器灌注（HMP）期间膜氧合的替代氧合技术（简便、廉价且与航空运输兼容），以改善猪缺血再灌注自体移植模型中的早期移植物功能。
一只约40公斤重的猪的左肾在经历22小时的保存和自体移植之前，先经历30分钟的热缺血。在实验组中，HMP期间灌注液的氧合通过直接气泡法以及在缺血开始时和结束时各进行30分钟的表面氧合来实现（n = 4），并将结果指标与无主动氧合的历史HMP组（n = 6）、22小时持续氧合HMP（HMPO）组（n = 8）以及2小时HMPO + 20小时HMP组（n = 6）进行比较，历史氧合对照组均使用膜氧合。
灌注液的短暂气泡法和30分钟表面氧合在HMP的前2小时有效地维持了超生理水平的Po，同时改善了血流动力学。尽管与气泡法和间断表面氧合相比，在HMP开始时短暂进行氧气加载后，使用膜氧合器时灌注液（即黄素单核苷酸）和组织（即谷氨酸、三磷酸腺苷）的代谢谱似乎稍好，但与无主动氧合的HMP相比，这两种技术均产生了相似的、更优的早期移植物功能。
本可行性研究中的数据支持以下结论：与无主动氧合的HMP相比，短暂气泡法和间歇性表面氧合可作为HMP期间的一种替代氧合技术，以实现更好的肾移植功能；与膜式HMPO相比，其功能结果相似。
