ISSN 1006-298X      CN 32-1425/R

导航

肾脏病与透析肾移植杂志 ›› 2021, Vol. 30 ›› Issue (3): 234-238.DOI: 10.3969/j.issn.1006298X.2021.03.008

• • 上一篇    下一篇

低温机械灌注对扩大标准供者供肾保存效果的单中心随机对照研究

  

  • 出版日期:2021-06-28 发布日期:2021-06-22

A single center study on effect of LifePort continuous hypothermic perfusion on preservation of marginal donor kidney of donation after cardiac death

  • Online:2021-06-28 Published:2021-06-22

摘要: 目的:分析低温机械灌注保存扩大标准供者(ECD)供肾对肾移植术后受者移植肾功能早期恢复的影响及移植后随访情况,从而探讨其优势。
方法:郑州人民医院器官移植中心2016年1月至2019年1月完成ECD供肾移植120例,采用简单随机化分组将供者一侧肾脏用LifePort持续低温灌注(LifePort组,n=120),另一侧肾脏使用静态冷保存(冷保存组,n=120),然后进行同种异体肾脏移植手术,观察两组受者术后早期移植肾功能结果、移植物存活率、术后并发症的发生情况。
结果:两组受者在术后没有发生DGF的情况下, 术后2周左右恢复正常并维持在稳定水平。与冷保存组比较,LifePort组受者血清肌酐(SCr)平均值降低幅度更大,出院时LifePort组SCr均值明显低于低温静态组(11418±1440 μmol/L vs 13308±2179 μmol/L,P=0025)。术后1个月、3个月和6个月、1年时,两组受者的SCr值比较,差异均无统计学意义。术后1年时,LifePort组受者的移植肾存活率为992%(119/120),高于低温静态组的975%(117/120),但两组差异无统计学意义(P=0097)。LifePort组受者术后移植肾功能恢复延迟(DGF)发生率明显低于低温静态组(108% vs 225%,P=0024)。两组受者术后急性排斥反应、外科并发症及感染等发生率的比较,差异均无统计学意义。
结论:LifePort低温机械灌注保存供肾,可以减少供肾缺血再灌注损伤程度,显著降低移植术后DGF发生率,移植术后早期SCr均明显优于低温静态保存的供肾,尤其是对ECD效果更为显著。


关键词: 肾移植,扩大标准供者,LifePort,器官保存,移植肾功能延迟恢复

Abstract: Objective:Due to the shortage of kidney donors, extended criteria donor (ECD) has been widely used in clinical practice, and hypothermic machinical perfusion for organ preservation has been given more attention. To study and analyze the effect of donation after cardiac death (DCD) marginal donor after Hypothermic machineperfusion on the early recovery of renal function in recipients after renal transplantation.
Methodology:Peoples hospital of Zhengzhou organ transplantation center from January 2016 to January 2019 finished edges of ECD transplantation 120 cases, randomly to one side each donor kidneys and kidney with LifePort continued low perfusion (LifePort group, n=120), another side kidney use low temperature static preservation (low temperature static group, n=120), and then on the allograft kidney transplant, early postoperative observation group 2 recipients transplanted kidney index, survival rate, complications occurred.
Results:In the absence of postoperative DGF, the two groups of recipients returned to normal and remained at a stable level about 2 weeks after the operation. Compared with the lowtemperature static group, the mean Scr in the LifePort group was significantly lower than that in the lowtemperature static group (11418±1440 μmol/L) at discharge, and the difference was statistically significant (P=0025). There was no significant difference in serum creatinine values between the two groups at 1 month, 3 months, 6 months and 1 year after surgery (P>005). At 1 year after surgery, the survival rate of the LifePort group was 991% (119/120), higher than that of the hypothermic static group (975%, 117/120), but the difference between the two groups was not statistically significant (P=0097). The incidence of delayed graft function (DGF) in LifePort group was 108% (13/120), which was significantly lower than that in the hypothermic static group (225%,27/120), and the difference between the two groups was statistically significant (P=0024). There were no statistically significant differences in the incidence of postoperative acute rejection, surgical complications and infection between the two groups (P>005).
Conclusion:The application of LifePort in DCD renal perfusion preservation can reduce the degree of ischemia reperfusion injury of the donor kidney, significantly reduce the incidence of DGF after transplantation, and the early urine volume and serum creatinine recovery level after transplantation are significantly superior to those of the donor kidney stored at low temperature, especially for marginal donors.


Key words: kidney transplantation, extended criteria donor, LifeP, ortorgan preservation, delayed graft function recovery