Andras Iulia, Piana Alberto, Verri Paolo, Telecan Teodora, Gallioli Andrea, Prudhomme Thomas, Hevia Vital, Baboudjian Michael, Boissier Romain, Crisan Nicolae, Campi Riccardo, Breda Alberto, Territo Angelo
Department of Urology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca-Napoca, Romania.
Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy.
World J Urol. 2023 Apr;41(4):993-1003. doi: 10.1007/s00345-023-04328-9. Epub 2023 Feb 24.
The lack of a reliable and reproducible technique to ensure a constantly low temperature of the graft during kidney transplantation (KT) may be a cause of renal nonfunction. The aim of this review was to assess all the methods and devices available to ensure hypothermia during vascular anastomosis in KT.
A literature search was conducted through May 2022 using PubMed/Medline, Cochrane Library, Embase and Web of Science databases. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed to identify eligible studies. The review protocol was registered on PROSPERO (CRD42022326550).
A total of 20 studies reporting on four hypothermia techniques met our inclusion criteria. Simple instillation of cold serum is not sufficient, the graft reaching up to 33 ℃ at the end of warm ischemia time (WIT). Plastic bags filled with ice slush have questionable efficiency. The use of a gauze jacket filled with ice-slush was reported in 12/20 studies. It ensures a graft temperature up to 20.3 ℃ at the end of WIT. Some concerns have been linked to potentially inhomogeneous parenchymal cooling and secondary ileus. Novel devices with continuous flow of ice-cold solution around the graft might overcome these limitations, showing a renal temperature below 20 ℃ at all times during KT.
The gauze filled with ice slush is the most common technique, but several aspects can be improved. Novel devices in the form of cold-ischemia jackets can ensure a lower and more stable temperature of the graft during KT, leading to higher efficiency and reproducibility.
在肾移植（KT）过程中，缺乏一种可靠且可重复的技术来确保移植物持续处于低温状态可能是导致肾功能丧失的一个原因。本综述的目的是评估在KT血管吻合过程中可用于确保低温的所有方法和装置。
通过使用PubMed/Medline、Cochrane图书馆、Embase和科学网数据库进行文献检索，检索截至2022年5月的文献。遵循系统评价和Meta分析的首选报告项目（PRISMA）指南来确定符合条件的研究。该综述方案已在PROSPERO（CRD42022326550）上注册。
共有20项报告四种低温技术的研究符合我们的纳入标准。单纯滴注冷血清是不够的，在热缺血时间（WIT）结束时移植物温度可达33℃。装满冰泥的塑料袋效率存疑。20项研究中有12项报告了使用装满冰泥的纱布套。它可确保在WIT结束时移植物温度达到20.3℃。一些问题与实质冷却可能不均匀以及继发性肠梗阻有关。新型装置可使冰冷溶液在移植物周围持续流动，可能会克服这些局限性，在KT过程中始终使肾脏温度低于20℃。
装满冰泥的纱布是最常用的技术，但在几个方面仍可改进。冷缺血套形式的新型装置可在KT过程中确保移植物温度更低且更稳定，从而提高效率和可重复性。
