Matsuno N, Sakurai E, Uchiyama M, Kozaki K, Miyamoto K, Kozaki M, Nagao T
The 5th Department of Surgery, Hachioji Medical Center, Tokyo Medical College, Hachioji-city, Japan.
Clin Transplant. 1998 Feb;12(1):1-4.
The shortage of kidneys for transplantation is a universal problem. If the viability of the kidney can be assured, organ procurement from non-heartbeating donors will be greatly enhanced. This study evaluates the usefulness of machine perfusion preservation parameters as an index of kidney graft viability. We report our experience with 77 non-heartbeating donor kidneys preserved with machine perfusion technique. Sixty-eight grafts demonstrated excellent perfusion (mean flow 0.79 ml/min/g) with low vascular resistance (55.4 mmHg/ml/min/g). Early graft function occurred in all of these kidneys. Nine kidneys demonstrated poor perfusion (mean flow 0.35 ml/min/g) and elevated pressures with high vascular resistance (132.5 mmHg/ml/min/g). Four kidneys with poor perfusion and elevated pressures was discarded after perfusion. The four mates of these discarded at our center were primarily non-functional when transplanted at another transplant center. All five of the poorly perfused kidneys experienced primary non-function. We conclude that the use of quantitative values of perfusion flow (> 0.4 ml/min/g) and no increased pressure pattern allow safe utilization of grafts from non-heartbeating donors and can predict early postoperative function.
肾脏移植供体短缺是一个全球性问题。如果能确保肾脏的活力，那么来自非心脏骤停供体的器官获取量将大幅增加。本研究评估了机器灌注保存参数作为肾移植活力指标的有效性。我们报告了77例采用机器灌注技术保存的非心脏骤停供体肾脏的经验。68例移植物表现出良好的灌注（平均流量0.79毫升/分钟/克），血管阻力较低（55.4毫米汞柱/毫升/分钟/克）。所有这些肾脏均出现早期移植物功能。9例肾脏灌注不佳（平均流量0.35毫升/分钟/克），压力升高，血管阻力高（132.5毫米汞柱/毫升/分钟/克）。4例灌注不佳且压力升高的肾脏在灌注后被丢弃。在我们中心被丢弃的这4例肾脏的配对肾脏，在另一个移植中心移植时基本无功能。所有5例灌注不佳的肾脏均发生原发性无功能。我们得出结论，使用灌注流量定量值（>0.4毫升/分钟/克）且压力无升高模式可安全利用非心脏骤停供体的移植物，并可预测术后早期功能。
