体外常温机器灌注在急性肾损伤的脑死亡供体肾移植中的应用：初步经验
Application of Ex Vivo Normothermic Machine Perfusion in Deceased Donors With Acute Kidney Injury With Successful Renal Transplantation: A Preliminary Experience.
作者信息
Choudhary Devprakash, Sharma Ashish, Singh Sarbpreet, Kenwar Deepesh B, Walker Minz Ranjana, Singh Kohli Harbir, Nada Ritambhra, Wangkheimayum Sujata, Jain Kajal, Patil Shivakumar S
机构信息
Department of Renal Transplant Surgery, Post Graduate Institute of Medical Education & Research, Chandigarh, India.
Department of Pathology, Post Graduate Institute of Medical Education & Research, Chandigarh, India.
出版信息
Transplant Direct. 2022 Oct 24;8(11):e1391. doi: 10.1097/TXD.0000000000001391. eCollection 2022 Nov.
UNLABELLED
Ex vivo normothermic machine perfusion (NMP) has improved organ preservation and viability assessment among heart, liver, and lung transplantation. However, literature regarding the application of NMP in human clinical kidney transplantation remains limited. Numerous kidneys, especially from donors with stage 3 acute kidney injury (AKI), are not utilized concerning the high rate of delayed graft function (DGF) and primary nonfunction. The present study investigated the impact of NMP (135-150 min) on short-term outcomes after kidney transplantation from deceased donors with AKI.
METHODS
Graft outcomes of NMP kidneys were compared with contralateral kidneys stored in static cold storage (SCS) from the same donor with AKI during December 2019-June 2021. The study's primary aim is to assess the safety and feasibility of NMP in deceased donors with AKI. The primary outcome was DGF. Secondary outcomes were duration of DGF, biopsy-proven rejection, postoperative intrarenal resistive index, postoperative infections, hospital stay duration, primary nonfunction, and kidney function estimated glomerular filtrate rate at discharge, 3 mo, and 1 y.
RESULTS
Five pairs of AKI kidneys (NMP versus SCS) were included in the final analysis. The results show no statistically significant differences in clinical outcomes between NMP versus SCS kidneys; however, NMP kidneys demonstrated slightly improved estimated glomerular filtrate rate at 3 mo (59.8 ± 5.93 [59] versus 75.20 ± 14.94 [74]) mL/min/1.73 m ( < 0.065) and at the last follow-up (12-29 mo) (72.80 ± 10.71 [75]) versus (94 ± 22.67 [82]) mL/min/1.73 m ( < 0.059) as compared with SCS kidneys. A higher proportion of NMP kidneys had normal intrarenal resistive index (0.5-0.7) and mild acute tubular injury on protocol biopsy, suggesting NMP is safe and feasible in deceased donors with acute kidney injury.
CONCLUSIONS
NMPs of AKI donor kidneys are safe and feasible. A larger cohort is required to explore the reconditioning effect of NMP on AKI kidneys.
未标记
体外常温机器灌注（NMP）已改善了心脏、肝脏和肺移植中的器官保存及活力评估。然而，关于NMP在人类临床肾移植中的应用的文献仍然有限。许多肾脏，尤其是来自患有3期急性肾损伤（AKI）供体的肾脏，由于移植肾功能延迟恢复（DGF）和原发性无功能的高发生率而未被利用。本研究调查了NMP（135 - 150分钟）对AKI已故供体肾移植后短期结局的影响。
方法
将2019年12月至2021年6月期间来自同一AKI供体的NMP肾脏的移植结局与对侧静态冷藏（SCS）保存的肾脏进行比较。该研究的主要目的是评估NMP在AKI已故供体中的安全性和可行性。主要结局是DGF。次要结局包括DGF持续时间、活检证实的排斥反应、术后肾内阻力指数、术后感染、住院时间、原发性无功能以及出院时、3个月和1年时估算肾小球滤过率的肾功能。
结果
最终分析纳入了5对AKI肾脏（NMP组与SCS组）。结果显示，NMP组与SCS组肾脏的临床结局无统计学显著差异；然而，与SCS组肾脏相比，NMP组肾脏在3个月时估算肾小球滤过率略有改善（59.8 ± 5.93 [59] 对 75.20 ± 14.94 [74]）mL/min/1.73 m²（P < 0.065），在最后随访（12 - 29个月）时（72.80 ± 10.71 [75]）对（94 ± 22.67 [82]）mL/min/1.73 m²（P < 0.059）。较高比例的NMP组肾脏在方案活检时肾内阻力指数正常（0.5 - 0.7）且有轻度急性肾小管损伤，表明NMP在AKI已故供体中是安全可行的。
结论
AKI供体肾脏的NMP是安全可行的。需要更大的队列来探索NMP对AKI肾脏的修复作用。
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