Department of Surgery, Nephrology Center, Toranomon Hospital Kajigaya, Tokyo, Japan.
Department of Surgery, Nephrology Center, Toranomon Hospital Kajigaya, Tokyo, Japan.
Transplant Proc. 2021 Jul-Aug;53(6):1831-1835. doi: 10.1016/j.transproceed.2021.03.045. Epub 2021 May 4.
After the revised organ transplant law came into effect in Japan, donations of organs under brain death have been increasing; however, because of the expansion of donor indications, donations from expanded criteria donors and cardiac arrest donors (donation after cardiac death) have also increased. In kidney transplantation, ischemia-reperfusion injury results in a high rate of delayed graft function, which adversely affects patients' long-term prognoses. Hypothermic machine perfusion preservation results in superior postoperative function and survival rates compared with cold storage preservation. We used an organ preservation device for kidneys and performed a graft viability evaluation before to kidney transplantation.
We used the CMP-X08 perfusion device (Chuo-Seiko Co, Ltd, Asahikawa, Hokkaido, Japan) and Belzer MPS solution to preserve the donated organ. The perfusion pressure and temperature were monitored during cold storage with continuous perfusion. Standard renal transplantation protocols were followed. A renal biopsy was performed 1 hour after transplantation and the renal function was evaluated. This study followed the principles of the Declaration of Helsinki.
The first presented case is of a 63-year-old woman who received a kidney from a middle-aged man with brain death due to hypoxic encephalopathy. The creatinine at the time of admission was 0.9 mg/dL and at the time of excision was 2.86 mg/dL. The total perfusion time was 120 minutes. The total ischemia time was 7 hours and 15 minutes. The recipient urinated 115 minutes postoperatively, and no dialysis was required. The second presented case is of a 47-year-old man with a 15-year history of dialysis who received a kidney from a middle-aged woman with brain death due to subarachnoid hemorrhage. The creatinine at the time of admission was 0.8 mg/dL and at the time of excision was 0.77 mg/dL. The total perfusion time was 240 minutes. The total ischemia time was 13 hours and 14 minutes. The recipient urinated 38 minutes postoperatively, and no dialysis was required.
Mechanical perfusion storage performed for 2 to 4 hours resulted in a viable organ that was successfully transplanted in both cases.
日本修订器官移植法生效后，脑死亡供体的器官捐献有所增加；但由于供体适应证扩大，扩展标准供体和心脏停搏供体（死后捐献）的捐献也有所增加。在肾移植中，缺血再灌注损伤导致延迟移植物功能障碍的发生率较高，这对患者的长期预后不利。与冷藏保存相比，低温机器灌注保存可获得更好的术后功能和存活率。我们使用器官保存装置对肾脏进行了保存，并在移植前对供体进行了移植物活力评估。
我们使用 CMP-X08 灌注装置（北海道旭川市 Chuo-Seiko 株式会社）和 Belzer MPS 溶液保存捐献器官。在持续灌注的低温保存过程中监测灌注压力和温度。采用标准的肾移植方案。移植后 1 小时进行肾活检，评估肾功能。本研究遵循《赫尔辛基宣言》的原则。
第一个病例是一位 63 岁的女性，她接受了一位因缺氧性脑病导致脑死亡的中年男性的肾脏。入院时肌酐为 0.9mg/dL，切除时为 2.86mg/dL。总灌注时间为 120 分钟。总缺血时间为 7 小时 15 分钟。受者术后 115 分钟排尿，无需透析。第二个病例是一位 47 岁的男性，有 15 年透析史，他接受了一位因蛛网膜下腔出血导致脑死亡的中年女性的肾脏。入院时肌酐为 0.8mg/dL，切除时为 0.77mg/dL。总灌注时间为 240 分钟。总缺血时间为 13 小时 14 分钟。受者术后 38 分钟排尿，无需透析。
在这两个病例中，进行了 2 至 4 小时的机械灌注储存，成功移植了有活力的器官。
