Abouna G M, Samhan M S, Kumar M S, White A G, Silva O S
Transplant Proc. 1987 Feb;19(1 Pt 3):2051-5.
The results of 61 cadaveric allografts preserved for 30 to 76 hours were analyzed to determine the effect of cold ischemia time, the method of preservation, and the type of immunosuppression on early graft viability and long-term graft survival. Preservation in cold storage up to 50 hours gave a low incidence of nonfunction (4%) and of posttransplant dialysis (20%) and a high rate of function both at 1 month (96%) and at 2 years (60%). Cold ischemia time greater than 50 hours caused a significantly increased need for dialysis (58%) but without appreciable difference in graft function at 1 month or at 2 years. Preservation by machine had no advantage over preservation by simple cold storage when the cold ischemia time was less than 50 hours. When cold ischemia time exceeded 50 hours, machine preservation was associated with a significantly reduced incidence of posttransplant dialysis but without significant differences in long-term function at 2 years. With up to 50 hours of cold ischemia and providing there was no ATN, CsA had little nephrotoxicity and gave excellent graft function at 1 month and at 2 years. However, the nephrotoxicity of CsA was markedly increased when the preservation interval exceeded 50 hours, resulting in a significantly increased rate of primary nonfunction and the need for dialysis with a significant decrease in graft function at 1 month and at 2 years. The nephrotoxicity of CsA was considerably decreased or eliminated without affecting its powerful immunosuppressive property when initial immunosuppression was begun with azathioprine with sequential conversion to CsA when graft function was fully established. It is recommended that when cold ischemia is long or when there is ATN, CsA should be used as a sequential therapy to azathioprine after graft diuresis or, alternatively, in much smaller doses as part of a combination therapy with azathioprine.
分析了61例保存30至76小时的尸体同种异体移植结果，以确定冷缺血时间、保存方法和免疫抑制类型对早期移植物存活及长期移植物存活的影响。冷藏保存达50小时，无功能发生率低（4%），移植后透析发生率低（20%），1个月时功能率高（96%），2年时功能率高（60%）。冷缺血时间超过50小时，透析需求显著增加（58%），但1个月或2年时移植物功能无明显差异。当冷缺血时间少于50小时时，机器保存与单纯冷藏保存相比无优势。当冷缺血时间超过50小时，机器保存与移植后透析发生率显著降低相关，但2年时长期功能无显著差异。冷缺血时间达50小时且无急性肾小管坏死时，环孢素肾毒性小，1个月和2年时移植物功能良好。然而，当保存时间超过50小时，环孢素肾毒性显著增加，导致原发性无功能发生率和透析需求显著增加，1个月和2年时移植物功能显著下降。当初始免疫抑制用硫唑嘌呤开始，移植物功能完全建立后序贯转换为环孢素时，环孢素肾毒性显著降低或消除，而不影响其强大的免疫抑制特性。建议当冷缺血时间长或有急性肾小管坏死时，环孢素应在移植物利尿后作为硫唑嘌呤的序贯疗法使用，或者，作为与硫唑嘌呤联合疗法的一部分，以小得多的剂量使用。
