Continuous Normothermic Ex Vivo Kidney Perfusion Improves Graft Function in Donation After Circulatory Death Pig Kidney Transplantation
Continuous Normothermic Ex Vivo Kidney Perfusion Improves Graft Function in Donation After Circulatory Death Pig Kidney Transplantation
复制标题
DOI：
10.1097/tp.0000000000001343
复制
发表时间：
2017-04-01
期刊：
影响因子：
6.2
通讯作者：
Selzner, Markus
中科院分区：
文献类型：
--
作者：
Kaths, J. Moritz;Echeverri, Juan;Selzner, Markus
背景资料。循环死亡后捐献(DCD)是目前临床上增加供者储备的做法。描述了低温保存对移植肾功能的有害影响。因此，目前的研究主要集中在研究其他保存技术，如常温灌流。方法：研究方法。在猪DCD自体移植模型中，我们比较了持续压力控制的常温体外肾灌流(NEVKP)和静态冷藏(SCS)。热缺血30min后，取30 kg大白猪右肾，用NEVKP或4℃组氨酸-色氨酸-酮戊二酸(SCS)液保存8h后，行自体肾移植。结果。在整个NEVKP过程中，电解质和pH值都保持不变。肾内阻力在灌流过程中呈下降趋势(0.005小时，每分钟1.6+/-0.51 mm vs 7小时，0.34+/-0.05毫米汞柱/毫升，P=0.05)。灌流液乳酸浓度下降(0.001小时，10.5+/-0.8vs7小时，1.4+/-0.3 mm ol/L，P<；0.05)。细胞损伤标志物乳酸脱氢酶和天冬氨酸氨基转移酶持续低(乳酸脱氢酶100U/L，低于分析仪范围；天冬氨酸转氨酶0h，15.6+/-9.3U/L vs 7h，24.8+/-14.6U/L，P=0.298)。自体肾移植后，用NEVKP保存的移植肾在移植后第1~7天血肌酐降低(P<0.002)，峰值降低(NVKP5.5±-1.7 mg/dL vs SCS11.1+/-2.1 mg/dL，P=0.05)。NEVKP保存组术后第4天的内生肌酐清除量明显高于SCS组(39+/-6.4vs18+/-10.6mL/min，P=0.012)。NEVKP组第3天血清中性粒细胞明胶酶相关脂蛋白低于对照组(1267+/-372vs2697+/-1145 ng/mL，P=0.029)。结论。持续压力控制NEVKP改善DCD肾移植肾功能常温体外肾脏灌流可能有助于降低移植后延迟移植物功能发生率，增加供体储备。
Background. Donation after circulatory death (DCD) is current clinical practice to increase the donor pool. Deleterious effects on renal graft function are described for hypothermic preservation. Therefore, current research focuses on investigating alternative preservation techniques, such as normothermic perfusion. Methods. We compared continuous pressure-controlled normothermic ex vivo kidney perfusion (NEVKP) with static cold storage (SCS) in a porcine model of DCD autotransplantation. After 30 minutes of warm ischemia, right kidneys were removed from 30-kg Yorkshire pigs and preserved with 8-hour NEVKP or in 4 degrees C histidine-tryptophan-ketoglutarate solution (SCS), followed by kidney autotransplantation. Results. Throughout NEVKP, electrolytes and pH values were maintained. Intrarenal resistance decreased over the course of perfusion (0 hour, 1.6 +/- 0.51 mm per minute vs 7 hours, 0.34 +/- 0.05 mm Hg/mL per minute, P = 0.005). Perfusate lactate concentration also decreased (0 hour, 10.5 +/- 0.8 vs 7 hours, 1.4 +/- 0.3 mmol/L, P < 0.001). Cellular injury markers lactate dehydrogenase and aspartate aminotransferase were persistently low (lactate dehydrogenase < 100 U/L, below analyzer range; aspartate aminotransferase 0 hour, 15.6 +/- 9.3 U/L vs 7 hours, 24.8 +/- 14.6 U/L, P = 0.298). After autotransplantation, renal grafts preserved with NEVKP demonstrated lower serum creatinine on days 1 to 7 (P < 0.05) and lower peak values (NEVKP, 5.5 +/- 1.7 mg/dL vs SCS, 11.1 +/- 2.1 mg/dL, P = 0.002). The creatinine clearance on day 4 was increased in NEVKP-preserved kidneys (NEVKP, 39 +/- 6.4 vs SCS, 18 +/- 10.6 mL/min; P = 0.012). Serum neutrophil gelatinase-associated lipocalin at day 3 was lower in the NEVKP group (1267 +/- 372 vs 2697 +/- 1145 ng/mL, P = 0.029). Conclusions. Continuous pressure-controlled NEVKP improves renal function in DCD kidney transplantation. Normothermic ex vivo kidney perfusion might help to decrease posttransplant delayed graft function rates and to increase the donor pool.