Preservation solutions for transplantation
Preservation solutions for transplantation
复制标题
DOI：
10.1016/s0041-1345(99)00265-1
复制
发表时间：
1999-08-01
影响因子：
0.9
通讯作者：
Mittermayer, C
中科院分区：
文献类型：
--
作者：
Mühlbacher, F;Langer, F;Mittermayer, C
由于葡萄糖的缺点，Eurocollins几乎被放弃。UW无疑是最常用的肝脏、肾脏和胰腺保存液，具有出色的临床和实验保存数据。UW当然可以被认为是当前的黄金标准解决方案。然而，高粘度、高价格、许多1-L袋不易处理的缺点，以及通过化学分析不能在袋中检测到自由基清除剂谷胱甘肽（可能是由于扩散）的事实，鼓励竞争者生产具有更好成本效果比的新化合物。HTK在心脏保存中具有稳固的地位;通过证明在保存肝脏和肾脏方面具有同等的安全性和有效性，至少在冷缺血时间的中、低范围内，HTK将被更频繁地使用，特别是考虑到更低的价格和更容易处理的方面。建议的高容量灌注实际上并不必要，基于多器官供体10 L总体积的计算显示出显着的成本降低。Celsior目前仅用于心脏保存。除了所有这些液体的保存和保存效力的所有方面之外，决不能忘记冷缺血本身是器官功能的风险因素。因此，冷缺血时间应尽可能短。人们愿意接受24小时或更长的冷缺血时间在肾移植，因为器官衰竭可以通过透析治疗。在其他器官中，即时器官功能是必不可少的，如在临床心脏移植中，冷缺血几乎从未超过6小时。为什么心脏和肾脏如此不同？很有可能没有差异，活体无关肾移植的突出结果主要是由于冷缺血时间短。
Eurocollins has almost been abandoned because of the glucose disadvantage. UW is certainly the most used preservation solution for livers, kidneys, and pancreases with excellent clinical and experimental preservation data. UW can certainly be considered the current golden standard solution. However, the disadvantage of high viscosity, high price, uneasy handling of many 1-L bags, and the fact that the radical scavenger glutathion cannot be detected in the bags by chemical analysis (presumably due to diffusion) encourage competitors to produce new compounds with better cost to effect ratios. HTK has a firm place in cardiac preservation; by demonstration of equal safety and efficacy in preserving livers and kidneys, at least in the middle and lower range of cold ischemia time, HTK will be sued more frequently, particularly with the consideration of lower price and more easy handling aspects. The suggested high volume perfusion is not really necessary, calculation based on a total volume of 10 L for a multiorgan donor show significant cost reductions. Celsior is current only used for cardiac preservation. Beyond all aspects of conservation and preservation potencies of all these fluids, it must not be forgotten that cold ischemia itself is a risk factor for organ function. Therefore, cold ischemia time should be kept as short as possible. People are willing to accept 24 hours or more cold ischemia time in kidney transplantation because organ failure can be treated by dialysis. In other organs, where immediate organ function is essential, like in clinical heart transplantation, cold ischemia is hardly ever extended beyond 6 hours. Why are hearts and kidneys so different? Very likely, there is no difference, and the outstanding results in living unrelated kidney transplants is mostly due to short cold ischemia time.