Department of Urology and Transplantation Surgery, University Hospital Center, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 03, France.
Nuffield Department of Surgical Science, Oxford, UK.
World J Urol. 2022 Sep;40(9):2141-2152. doi: 10.1007/s00345-021-03757-8. Epub 2021 Aug 25.
The main objective of static cold storage is to reduce cellular metabolic demands to extend the period of ischaemia prior to transplantation. Hypothermia does not halt metabolism and the absence of oxygen causes a cellular shift toward anaerobic respiratory pathways. There is emerging evidence that the introduction of oxygenation during organ preservation may help ameliorate the degree of ischaemia reperfusion injury and improve post-transplantation outcomes. This review aims to appraise and summarise all published literature that utilises oxygenation to improve kidney preservation for purposes of transplantation.
We performed a scoping review of the literature using the bibliographic databases Embase and MEDLINE. The final date for searches was 20 March 2021. All research studies included were those that reported oxygen delivery during kidney preservation as well as providing a description of the oxygenation technique.
17 human and 48 animal studies met the inclusion criteria. The oxygen delivery methods investigated included hypothermic oxygenated machine perfusion (HOPE), oxygen carriers, two-layer method, venous systemic persufflation, hyperbaric oxygenation, normothermic machine perfusion and sub-normothermic machine perfusion. The COMPARE trial was the only study carried out with the most methodological robustness being a randomised, double blind, controlled, phase III trial that investigated the efficacy of HOPE versus HMP.
A variety of studies reflect the evolution of oxygenation with useful lessons and encouraging outcomes. The first in human studies investigating HOPE and oxygen carriers are most robustly investigated strategies for oxygenation during kidney preservation and are, therefore, the best clinical references.
静态低温冷藏的主要目的是降低细胞代谢需求，延长移植前的缺血期。低温并不能停止代谢，而缺氧会导致细胞向无氧呼吸途径转移。有新的证据表明，在器官保存过程中引入氧合作用可能有助于减轻缺血再灌注损伤的程度，并改善移植后的结果。本综述旨在评估和总结所有利用氧合作用改善肾脏保存以用于移植的已发表文献。
我们使用文献数据库 Embase 和 MEDLINE 对文献进行了范围界定综述。搜索的最后日期是 2021 年 3 月 20 日。所有纳入的研究均报告了肾脏保存期间的供氧情况，并描述了氧合技术。
符合纳入标准的有 17 项人体研究和 48 项动物研究。所研究的供氧方法包括低温含氧机器灌注（HOPE）、氧载体、双层法、静脉全身吹入、高压氧、常温机器灌注和亚常温机器灌注。COMPARE 试验是唯一一项方法学最稳健的随机、双盲、对照、III 期试验，该试验研究了 HOPE 与 HMP 的疗效。
各种研究反映了氧合作用的发展，具有有用的经验和令人鼓舞的结果。在人体中首次研究 HOPE 和氧载体是最稳健的氧合策略，是肾脏保存期间氧合的最佳临床参考。
