Programa de Pós-Graduação em Ciências Cirúrgicas, Departamento de Cirurgia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro - UFRJ, Rio de Janeiro, RJ, Brasil.
Programa de Pós-Graduação em Clínica Médica, Disciplina de Nefrologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro - UFRJ, Rio de Janeiro, RJ, Brasil.
Int Braz J Urol. 2024 Jul-Aug;50(4):470-479. doi: 10.1590/S1677-5538.IBJU.2024.0166.
The clinical outcomes of kidney transplantation from deceased donors have seen significant improvements with the use of machine perfusion (MP), now a standard practice in transplant centers. However, the use of perfusate biomarkers for assessing organ quality remains a subject of debate. Despite this, some centers incorporate them into their decision-making process for donor kidney acceptance. Recent studies have indicated that lactate dehydrogenase (LDH), glutathione S-transferase, interleukin-18, and neutrophil gelatinase-associated lipocalin (NGAL) could predict post-transplant outcomes.
Between August 2016 and June 2017, 31 deceased-donor after brain death were included and stroke was the main cause of death. Pediatric patients, hypersensitized recipients were excluded. 43 kidneys were subjected to machine perfusion. Perfusate samples were collected just before the transplantation and stored at -80ºC. Kidney transplant recipients have an average age of 52 years, 34,9% female, with a BMI 24,6±3,7. We employed receiver operating characteristic analysis to investigate associations between these perfusate biomarkers and two key clinical outcomes: delayed graft function and primary non-function.
The incidence of delayed graft function was 23.3% and primary non-function was 14%. A strong association was found between NGAL concentration and DGF (AUC=0.766, 95% CI, P=0.012), and between LDH concentration and PNF (AUC=0.84, 95% CI, P=0.027). Other perfusate biomarkers did not show significant correlations with these clinical outcomes.
The concentrations of NGAL and LDH during machine perfusion could assist transplant physicians in improving the allocation of donated organs and making challenging decisions regarding organ discarding. Further, larger-scale studies are required.
使用机器灌注（MP）可显著改善来自已故供体的肾脏移植的临床结果，现在这已成为移植中心的标准实践。但是，使用灌流液生物标志物来评估器官质量仍然存在争议。尽管如此，一些中心仍将其纳入其接受供体肾脏的决策过程中。最近的研究表明，乳酸脱氢酶（LDH）、谷胱甘肽 S-转移酶、白细胞介素 18 和中性粒细胞明胶酶相关脂质运载蛋白（NGAL）可预测移植后的结果。
2016 年 8 月至 2017 年 6 月期间，纳入了 31 例脑死亡后的已故供体，主要死因是中风。排除小儿患者和高敏受者。43 个肾脏接受了机器灌注。在移植前采集灌流液样本，并储存在-80°C。肾移植受者的平均年龄为 52 岁，女性占 34.9%，BMI 为 24.6±3.7。我们采用接收者操作特征分析来研究这些灌流液生物标志物与两个关键临床结果（即延迟性移植物功能障碍和原发性无功能）之间的关联。
延迟性移植物功能障碍的发生率为 23.3%，原发性无功能的发生率为 14%。NGAL 浓度与 DGF 之间存在很强的关联（AUC=0.766，95%CI，P=0.012），而 LDH 浓度与 PNF 之间存在很强的关联（AUC=0.84，95%CI，P=0.027）。其他灌流液生物标志物与这些临床结果之间无显著相关性。
机器灌注期间 NGAL 和 LDH 的浓度可以帮助移植医生改善捐赠器官的分配，并在器官废弃方面做出具有挑战性的决策。还需要更大规模的研究。
