低温机器灌注在 deceased 供肾中的应用及结果：一项回顾性队列研究。

Hypothermic machine perfusion utilization and outcomes for deceased-donor kidneys: A retrospective cohort study.

作者信息

Krishnamoorthy Vijay, Qiu Qian, Souter Michael J

机构信息

Department of Anesthesiology, Duke University, Durham, NC, USA.

Department of Anesthesiology, Critical Care and Perioperative Epidemiologic Research Unit, Duke University, Durham, NC, USA.

出版信息

Int J Crit Illn Inj Sci. 2020 Sep;10(Suppl 1):17-20. doi: 10.4103/IJCIIS.IJCIIS_22_20. Epub 2020 Sep 16.

DOI:10.4103/IJCIIS.IJCIIS_22_20

PMID:33376685

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7759075/

Abstract

INTRODUCTION

Hypothermic machine perfusion (HMP) has been established as an efficacious method for preserving kidney allografts from deceased donors in clinical trials, but little data are available on the effectiveness of HMP in real-world settings. We examined factors associated with HMP use and clinical outcomes in a real-world organ procurement organization setting.

METHODS

We conducted a retrospective cohort study of the Lifecenter Northwest organ procurement database from 2010 to 2015, linked to the United Network of Organ Sharing outcomes database. We examined HMP utilization, and our primary outcomes were delayed graft function (DGF) and graft survival, using multivariable Poisson and Cox regression models.

RESULTS

Among 1729 deceased-donor kidneys, 797 (46%) were preserved with HMP. Higher donor age, region of procurement, and donation type were associated with HMP use. HMP was associated with a 37% decreased risk of DGF (adjusted relative risk 0.63, 95% confidence interval [CI]: 0.51-0.78), with no effect on 1-year graft survival (adjusted hazard ratio 0.83, 95% CI: 0.38-1.80).

CONCLUSION

Variation exists in the utilization of HMP for deceased donor kidneys. HMP reduced the risk for DGF, but was not associated with improvements in long-term graft survival.

摘要

引言

在临床试验中，低温机器灌注（HMP）已被确立为一种保存已故供体肾移植器官的有效方法，但关于HMP在实际应用中的有效性数据却很少。我们在一个实际的器官获取组织环境中研究了与HMP使用及临床结果相关的因素。

方法

我们对2010年至2015年西北生命中心器官获取数据库进行了一项回顾性队列研究，并与器官共享联合网络的结果数据库相链接。我们研究了HMP的使用情况，主要结果是延迟移植肾功能（DGF）和移植肾存活，采用多变量泊松回归和Cox回归模型。

结果

在1729个已故供体肾中，797个（46%）采用HMP保存。较高的供体年龄、获取地区和捐赠类型与HMP的使用相关。HMP与DGF风险降低37%相关（调整后的相对风险为0.63，95%置信区间[CI]：0.51-0.78），对1年移植肾存活无影响（调整后的风险比为0.83，95%CI：0.38-1.80）。