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活体亲属供肾移植中,远程供者预处理以提高受体体内移植物存活率。

REMOTE DONOR PRECONDITIONING FOR INCREASING TRANSPLANT SURVIVAL IN THE RECIPIENT'S BODY DURING THE KIDNEY TRANSPLANTATION FROM THE LIVING-RELATED DONOR.

机构信息

STATE INSTITUTE SHALIMOV'S NATIONAL INSTITUTE OF SURGERY AND TRANSPLANTATION TO NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE, KYIV, UKRAINE, SHUPYK NATIONAL ACADEMY OF POSTGRADUATE EDUCATION, KYIV, UKRAINE.

SHUPYK NATIONAL ACADEMY OF POSTGRADUATE EDUCATION, KYIV, UKRAINE.

出版信息

Wiad Lek. 2022;75(2):397-403.

Abstract

OBJECTIVE

The aim: To estimate the protective effect of remote ischemic preconditioning (RIPC) on kidney transplants harvested from living related donors.

PATIENTS AND METHODS

Materials and methods: To achieve the claimed aim, there were examined 60 donor-recipient couples, where kidney transplant donors were living-related. All donors had the same anaesthetic management. The first group (n = 30) received RIPC which included four procedures of cuff inflations each lasting 5 minutes followed by 5-minute intervals of cuff deflation to measure blood pressure up to 40 mm Hg above systolic blood pressure on the shoulder. Patients of the second group (controls) did not experience RIPC (n = 30) and control group without RIPC.

RESULTS

Results: RIPC resulted in a statistically significant (P<0.05) increase in GFR of the transplanted kidney from 66±5 mL /min to 63±4 mL /min after 3 months, from 69±3 mL /min to 61±5 mL /min after 6 months, from 63±2.5 mL /min to 57±3 mL /min after 12 months; a 3-fold reduced partial delay of graft function; a 2-fold decreased incidence of acute kidney transplant rejection times; 1.5-fold decline in the incidence of primary non-function; and 1.4-fold tCr50 acceleration (p = 0.16). The follow-up period lasted for a year after transplantation.

CONCLUSION

Conclusions: RIPC during organ harvesting improved graft ischemic protection and increased functioning efficiency in the recipient.

摘要

目的

评估远程缺血预处理(RIPC)对活体亲属供肾移植的保护作用。

患者和方法

为了达到预期的目的,共检查了 60 对供受者夫妇,其中供肾者为活体亲属。所有供者均采用相同的麻醉管理。第一组(n=30)接受 RIPC,包括四次袖带充气,每次持续 5 分钟,然后袖带放气 5 分钟,将血压升高至肩部收缩压以上 40mmHg。第二组(对照组,n=30)未接受 RIPC,对照组未接受 RIPC。

结果

RIPC 导致移植肾 GFR 在 3 个月后从 66±5ml/min 增加到 63±4ml/min,在 6 个月后从 69±3ml/min 增加到 61±5ml/min,在 12 个月后从 63±2.5ml/min 增加到 57±3ml/min;部分移植物功能延迟减少了 3 倍;急性肾移植排斥的发生率降低了 2 倍;原发性无功能的发生率降低了 1.5 倍;tCr50 加速了 1.4 倍(p=0.16)。随访期在移植后持续 1 年。

结论

器官采集过程中的 RIPC 改善了移植物的缺血保护,并提高了受者的功能效率。

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