肾脏低温机器灌注可弥补延长的储存时间：单次干预带来重大影响。

Hypothermic Machine Perfusion of Kidneys Compensates for Extended Storage Time: A Single Intervention With a Significant Impact.

机构信息

Department of General, Oncological, Gastroenterological Surgery and Transplantation, University Hospital in Krakow, Poland.

出版信息

Transplant Proc. 2021 Apr;53(3):1085-1090. doi: 10.1016/j.transproceed.2021.01.022. Epub 2021 Feb 10.

DOI:10.1016/j.transproceed.2021.01.022

PMID:33579549

Abstract

INTRODUCTION

Delayed graft function (DGF) adversely affects graft survival and function. Machine perfusion (MP) improves DGF rate and may compensate for extended storage time.

MATERIAL AND METHODS

In this single-center cohort study, we included 193 consecutive kidney transplantations. MP was used in 78 kidneys (36%) and static cold storage (CS) in 115 kidneys (64%). CS kidneys were transplanted first followed by MP kidneys if stored differently. Pairs of kidneys from the same donor were subjected for subgroup analysis and included 58 pairs. The primary endpoints were the rate of DGF and 1- and 5-year graft survival. The secondary endpoints were the rate of the primary nonfunction, mortality, acute rejection, duration of DGF, and 5-year estimated glomerular filtration rate.

RESULTS

Median cold ischemia time (CIT) was significantly different between the MP and CS groups (24 vs 20 hours, P < .05). MP significantly reduced the rate of DGF (MP vs CS: 21.8% vs 42.6%, P < .05, odds ratio 0.34, 95% confidence interval 0.17-0.67) with no impact on overall 1- and 5-year survival rates. Storage method did not affect the duration of DGF, mortality rate, acute rejection, or the 5-year estimated glomerular filtration rate.

CONCLUSIONS

Hypothermic pulsatile MP significantly reduced the rate of DGF in kidneys transplanted with CIT equal to or longer than 12 hours. It is safe and may compensate for longer storage time.

摘要

简介

延迟移植物功能（DGF）会对移植物的存活率和功能产生不利影响。机器灌注（MP）可提高 DGF 发生率，并可能补偿延长的储存时间。

材料与方法

在这项单中心队列研究中，我们纳入了 193 例连续的肾移植患者。78 例（36%）使用 MP，115 例（64%）使用静态冷保存（CS）。CS 肾脏首先进行移植，如果储存方式不同，则移植 MP 肾脏。同一供体的配对肾脏进行亚组分析，共纳入 58 对。主要终点为 DGF 发生率以及 1 年和 5 年移植物存活率。次要终点为原发性无功能、死亡率、急性排斥反应、DGF 持续时间和 5 年估计肾小球滤过率。

结果

MP 组和 CS 组的冷缺血时间（CIT）中位数差异具有统计学意义（24 小时比 20 小时，P<.05）。MP 显著降低了 DGF 发生率（MP 组比 CS 组：21.8%比 42.6%，P<.05，比值比 0.34，95%置信区间 0.17-0.67），但对 1 年和 5 年总体存活率无影响。储存方式不影响 DGF 持续时间、死亡率、急性排斥反应或 5 年估计肾小球滤过率。