Artiles Medina Alberto, Burgos Revilla Francisco Javier, Álvarez Nadal Marta, Muriel García Alfonso, Álvarez Díaz Noelia, Gómez Dos Santos Victoria
Department of Urology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain.
Department of Nephrology, Hospital Universitario Ramón y Cajal, Madrid, Spain.
Transl Androl Urol. 2021 Aug;10(8):3286-3299. doi: 10.21037/tau-21-236.
Several techniques have been developed to reduce the warm ischaemic injury of donation after circulatory death (DCD) organs before procurement. There are scarce data about the preservation techniques for kidney graft outcomes. The aim of this systematic review was to evaluate the best preservation method for kidney graft outcomes from organs obtained from controlled and uncontrolled DCD.
A systematic review of the PubMed (MEDLINE), Embase, LILACS and Cochrane databases was conducted. Studies that compare two or more preservation techniques were identified and included. Only studies which provided enough data to calculate odds ratio were eligible for meta-analysis. PROSPERO registration: CRD42020179598.
The search strategy yielded 7,121 studies. Ultimately, 14 retrospective studies were included. Because of heterogeneity, the included studies provided weak evidence that normothermic regional perfusion (NRP) is the best preservation technique in terms of delayed graft function (DGF) rates. Regarding primary nonfunction (PNF), we carried out a meta-analysis of 10 studies with a pooled OR of 0.83 (95% CI: 0.40-1.71), for the NRP. In regard to DGF, pooled OR for NRP was 0.36 (95% CI: 0.25-0.54).
NRP in the DCD donor could improve kidney graft function and be considered the preservation technique of choice for abdominal organs.
为减少循环性死亡后器官捐献（DCD）器官在获取前的热缺血损伤，已开发出多种技术。关于肾移植结局的保存技术的数据稀缺。本系统评价的目的是评估从控制性和非控制性DCD获取的器官中，对肾移植结局最佳的保存方法。
对PubMed（MEDLINE）、Embase、LILACS和Cochrane数据库进行系统评价。识别并纳入比较两种或更多保存技术的研究。只有提供足够数据以计算比值比的研究才有资格进行荟萃分析。PROSPERO注册号：CRD42020179598。
检索策略产生了7121项研究。最终，纳入了14项回顾性研究。由于存在异质性，纳入的研究提供了薄弱证据，表明就移植肾功能延迟（DGF）发生率而言，常温区域灌注（NRP）是最佳的保存技术。关于原发性无功能（PNF），我们对10项研究进行了荟萃分析，NRP的合并比值比为0.83（95%CI：0.40 - 1.71）。关于DGF，NRP的合并比值比为0.36（95%CI：0.25 - 0.54）。
DCD供体中的NRP可改善肾移植功能，可被视为腹部器官的首选保存技术。
