Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
Department of Medicine, Imperial College London, London, United Kingdom.
Transplantation. 2021 Aug 1;105(8):1760-1770. doi: 10.1097/TP.0000000000003599.
Hypothermic machine perfusion (HMP) is a well-established method for deceased donor kidney preservation. Normothermic machine perfusion (NMP) might offer similar or greater advantages. We compared the 2 methods in an ex vivo perfusion model using 34 porcine kidneys.
Thirty kidneys were stored on ice for 24 h before undergoing 4 h of HMP (n = 15) or NMP (n = 15) followed by 2 h of normothermic ex vivo reperfusion with whole blood. Four kidneys underwent 28 h of cold static storage followed by 2 h of normothermic ex vivo reperfusion. During the 2 h of normothermic ex vivo reperfusion, perfusate flow rates, urinary output, and oxygen consumption rates were compared between all groups.
Porcine kidneys after HMP showed significantly higher urinary output (5.31 ± 2.06 versus 2.44 ± 1.19 mL/min; P = 0.002), oxygen consumption (22.71 ± 6.27 versus 11.83 ± 1.29 mL/min; P = 0.0016), and perfusate flow rates (46.24 ± 12.49 versus 26.16 ± 4.57 mL/min; P = 0.0051) than kidneys after NMP. TUNEL staining of tissue sections showed significantly higher rates of apoptosis in kidneys after NMP (P = 0.027).
In our study, the direct comparison of HMP and NMP kidney perfusion in a translational model demonstrated superiority of HMP; however, further in vivo studies would be needed to validate those results.
低温机器灌注（HMP）是一种成熟的用于保存供体肾脏的方法。常温机器灌注（NMP）可能具有类似或更大的优势。我们使用 34 个猪肾在离体灌注模型中比较了这 2 种方法。
30 个肾脏在冰上保存 24 小时后，进行 4 小时的 HMP（n = 15）或 NMP（n = 15），然后进行 2 小时的常温离体再灌注全血。4 个肾脏进行 28 小时的冷静态储存，然后进行 2 小时的常温离体再灌注。在 2 小时的常温离体再灌注期间，比较所有组之间的灌流液流速、尿量和耗氧量。
HMP 后的猪肾显示出明显更高的尿量（5.31 ± 2.06 与 2.44 ± 1.19 mL/min；P = 0.002）、耗氧量（22.71 ± 6.27 与 11.83 ± 1.29 mL/min；P = 0.0016）和灌流液流速（46.24 ± 12.49 与 26.16 ± 4.57 mL/min；P = 0.0051）高于 NMP 后的肾脏。组织切片的 TUNEL 染色显示，NMP 后肾脏的细胞凋亡率明显更高（P = 0.027）。
在我们的研究中，HMP 和 NMP 肾脏灌注的直接比较在转化模型中显示了 HMP 的优越性；然而，需要进一步的体内研究来验证这些结果。
