Division of Hepato-Pancreato-Biliary and Transplant Surgery, Department of Surgery, Erasmus MC University Medical Centre, Rotterdam, the Netherlands.
Nephrology and Transplantation, Department of Internal Medicine, Erasmus MC University Medical Centre, Rotterdam, the Netherlands.
BJS Open. 2021 Jan 8;5(1). doi: 10.1093/bjsopen/zraa024.
The 5-year graft survival rate of donor kidneys transplanted in the Eurotransplant Senior Program (ESP) is only 47 per cent. Normothermic machine perfusion (NMP) may be a new preservation technique that improves graft outcome. This pilot study aimed to assess safety and feasibility of this technique within the ESP.
Recipients were eligible for inclusion if they received a donor kidney within the ESP. Donor kidneys underwent 2 h of oxygenated NMP with a red cell-based solution at 37°C, additional to standard-of-care preservation (non-oxygenated hypothermic machine perfusion). The primary outcome was the safety and feasibility of NMP. As a secondary outcome, graft outcome was investigated and compared with that in a historical group of patients in the ESP and the contralateral kidneys.
Eleven patients were included in the NMP group; the function of eight kidneys could be compared with that of the contralateral kidney. Fifty-three patients in the ESP, transplanted consecutively between 2016 and 2018, were included as controls. No adverse events were noted, especially no arterial thrombosis or primary non-function of the transplants. After 120 min of oxygenated NMP, median flow increased from 117 (i.q.r. 80-126) to 215 (170-276) ml/min (P = 0.001). The incidence of immediate function was 64 per cent in the NMP group and 40 per cent in historical controls (P = 0.144). A significant difference in graft outcome was not observed.
This pilot study showed NMP to be safe and feasible in kidneys transplanted in the ESP. A well powered study is warranted to confirm these results and investigate the potential advantages of NMP on graft outcome.
在欧洲器官移植高级项目（ESP）中，供体肾脏的 5 年移植物存活率仅为 47%。常温机械灌注（NMP）可能是一种新的保存技术，可以改善移植物的预后。本研究旨在评估该技术在 ESP 中的安全性和可行性。
如果患者在 ESP 中接受供体肾脏，则有资格入组。供体肾脏在 37°C 下接受 2 小时充氧的 NMP 和基于红细胞的溶液，此外还进行标准保存（非充氧低温机械灌注）。主要结果是 NMP 的安全性和可行性。次要结果是研究移植物的预后，并与 ESP 中的历史组患者和对侧肾脏的移植物预后进行比较。
11 例患者纳入 NMP 组，8 例肾脏的功能可与对侧肾脏进行比较。ESP 中连续纳入 2016 年至 2018 年期间的 53 例患者作为对照组。未观察到不良事件，特别是没有动脉血栓形成或移植物原发性无功能。在充氧 NMP 120 分钟后，中位流量从 117（IQR 80-126）增加至 215（170-276）ml/min（P=0.001）。NMP 组的即时功能发生率为 64%，历史对照组为 40%（P=0.144）。未观察到移植物预后的显著差异。
本研究表明，在 ESP 中移植的肾脏中，NMP 是安全可行的。需要一项更大规模的研究来证实这些结果，并研究 NMP 对移植物预后的潜在优势。
