Verdiales Carlos, Baxter Luke, Lim Hyun Ja, Beck Gavin, Moser Michael A
Department of Surgery, University of Saskatchewan, Saskatoon, Saskatchewan S7N 0W8, Canada.
College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan S7N 0W8, Canada.
World J Transplant. 2024 Sep 18;14(3):95233. doi: 10.5500/wjt.v14.i3.95233.
Hypothermic machine perfusion (HMP) has demonstrated benefits in terms of early kidney transplant function compared to static cold storage. While longer preservation times have shown detrimental effects, a previous paired study indicated that longer pump times (the second kidney in a pair) might lead to improved outcomes.
To revisit the prior paired study's somewhat unexpected results by reviewing our program's experience.
A total of 61 pairs of transplant recipients who received kidneys from the same donor (2012-2021) were analyzed. Patients were divided into two groups depending on whether they were transplanted first (K1) or second (K2). Therefore, the patients in each pair had identical donor characteristics, except for time on the pump. Statistical analyses included Kaplan-Meyer analysis and paired tests, including McNemar's test, student's paired -test, or Wilcoxon's test, as appropriate.
The two groups of recipients had similar demographics (age, body mass index, diabetes, time on dialysis, sensitization and retransplants). Cold ischemic times for K1 and K2 were 8.9 (95%CI: 7.9, 9.8) and 14.7 hours (13.7, 15.8) ( < 0.0001), respectively. Overall, K2 had a higher rate of freedom from biopsy-proven acute rejection at 1 year ( = 0.015). Delayed graft function was less common in K2, 12/61 (20%) than in K1, 20/61 (33%) ( = 0.046). Finally, K2 showed a higher graft survival than K1 ( = 0.023).
Our results agree with a previous study that suggested possible advantages to longer pump times. Both studies should encourage further research into HMP's potential anti-inflammatory effect.
与静态冷藏相比，低温机器灌注（HMP）在早期肾移植功能方面已显示出优势。虽然较长的保存时间已显示出有害影响，但先前的一项配对研究表明，较长的灌注时间（一对中的第二个肾脏）可能会导致更好的结果。
通过回顾我们项目的经验，重新审视先前配对研究中一些出人意料的结果。
分析了2012年至2021年期间共61对接受来自同一供体肾脏的移植受者。根据患者是先接受移植（K1）还是后接受移植（K2）分为两组。因此，每对患者除了灌注时间外，供体特征相同。统计分析包括Kaplan - Meyer分析和配对检验，包括McNemar检验、学生配对t检验或Wilcoxon检验（视情况而定）。
两组受者的人口统计学特征相似（年龄、体重指数、糖尿病、透析时间、致敏情况和再次移植）。K1和K2的冷缺血时间分别为8.9小时（95%置信区间：7.9，9.8）和14.7小时（13.7，15.8）（P<0.0001）。总体而言，K2在1年时经活检证实的急性排斥反应的无事件发生率更高（P = 0.015）。移植肾功能延迟在K2中比在K1中更少见，分别为12/61（20%）和20/61（33%）（P = 0.046）。最后，K2的移植肾存活率高于K1（P = 0.023）。
我们的结果与先前一项表明较长灌注时间可能具有优势的研究一致。两项研究都应鼓励对HMP潜在的抗炎作用进行进一步研究。
