Transplant Center, Leiden University Medical Center, Leiden, the Netherlands; Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands.
Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands; Department of Nephrology, Leiden University Medical Center, Leiden, the Netherlands.
Kidney Int. 2021 Aug;100(2):301-310. doi: 10.1016/j.kint.2021.04.001. Epub 2021 Apr 20.
Normothermic machine perfusion (NMP) is emerging as a novel preservation strategy. During NMP, the organ is maintained in a metabolically active state that may not only provide superior organ preservation, but that also facilitates viability testing before transplantation, and ex situ resuscitation of marginal kidney grafts. Although the prevailing perfusion protocols for renal NMP are refined from initial pioneering studies concerning short periods of NMP, it could be argued that these protocols are not optimally tailored to address the putatively compromised metabolic plasticity of marginal donor grafts (i.e., in the context of viability testing and/or preservation), or to meet the metabolic prerequisites associated with prolonged perfusions and the required anabolic state in the context of organ regeneration. Herein, we provide a theoretical framework for the metabolic requirements for renal NMP. Aspects are discussed along the lines of carbohydrates, fatty acids, amino acids, and micronutrients required for optimal NMP of an isolated kidney. In addition, considerations for monitoring aspects of metabolic status during NMP are discussed.
体温保存（NMP）正在成为一种新的保存策略。在 NMP 过程中，器官保持在代谢活跃的状态，这不仅可以提供更好的器官保存，还可以在移植前进行活力测试，并在体外复苏边缘肾移植物。尽管用于肾脏 NMP 的主要灌注方案是从最初关于 NMP 短时间的开创性研究中提炼出来的，但可以说这些方案并不完全适合解决边缘供体移植物（即活力测试和/或保存）中假定受损的代谢可塑性问题，也不适合满足与长时间灌注相关的代谢要求以及在器官再生的情况下需要合成代谢状态。在这里，我们为肾脏 NMP 的代谢要求提供了一个理论框架。讨论了沿着孤立肾脏 NMP 所需的碳水化合物、脂肪酸、氨基酸和微量营养素的路线讨论了各个方面。此外，还讨论了在 NMP 过程中监测代谢状态各个方面的注意事项。
