Warm ischemia time does not correlate with recipient graft function in laparoscopic donor nephrectomy
Warm ischemia time does not correlate with recipient graft function in laparoscopic donor nephrectomy
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DOI：
10.1007/s00464-002-8860-4
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发表时间：
2003-05-01
影响因子：
3.1
通讯作者：
Flowers, JL
中科院分区：
文献类型：
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作者：
Buzdon, MM;Cho, E;Flowers, JL
背景：腹腔镜供体肾切除术（LDN）已被证明是一种安全有效的肾脏获取选择。比较开放性肾切除术和手助腹腔镜手术的研究强调，与“单纯”腹腔镜取肾术相比，热缺血时间缩短。然而，没有数据存在，确切地定义什么构成了一个长期的热缺血时间在受体移植功能方面。本研究的目的是使用一个大的，单机构的经验与LDN，以确定是否热缺血时间与受体移植功能测定血清肌酐levels.Methods：共640 LDN进行了1996年3月至2001年8月。前瞻性收集热缺血时间，并将其定义为从肾动脉闭塞到浸入冰盐水中的时间。在移植后1周和1、3、6和12个月（如果可能）测量连续受体肌酐水平。结果：热缺血时间35 ~ 720 s，平均151 s，标准误3.4 s。第1周时肌酐均值为1.94 mg/dl，标准误为0.06 mg/dl，范围为0.5 - 10.5 mg/dl。1个月时肌酐平均值为1.68 mg/dl，标准误为0.06 mg/dl，范围为0.6 - 8.5 mg/dl。3个月时肌酐均值为1.60 mg/dl，标准误为0.04 mg/dl，范围为0.6 - 8.8 mg/dl。6个月时肌酐均值为1.63 mg/dl，标准误为0.06 mg/dl，范围为0.7 - 13.5 mg/dl。12个月时肌酐均值为1.70 mg/dl，标准误为0.07 mg/dl，范围为0.5 - 14.5 mg/dl。热缺血时间与受体1周时肌酐水平无相关性（p = 0.4737），1个月（p = 0.9180），3个月（p = 0.6227），6个月（p = 0.8349）或12个月结论：在所研究的时间范围内，热缺血时间与LDN的受体移植物功能无关。与开放供肾切除术和手辅助LDN相关的较短热缺血时间并不一定能为受体移植物功能提供可测量的优势。在肾脏摘除过程中，尽量减少热缺血时间的权宜之计不应取代肾血管分离和肾脏摘除中的受控和安全操作。
Background: Laparoscopic donor nephrectomy (LDN) has been shown to be a safe and effective option for renal procurement. Studies comparing open nephrectomy and hand-assisted laparoscopy have emphasized decreased warm ischemia time when compared with "pure" laparoscopic retrieval. However, no data exist that define exactly what constitutes a prolonged warm ischemia time in terms of recipient graft function. The aim of this study was to use a large, single-institution experience with LDN to determine if warm ischemia time correlates with recipient graft function as measured by serum creatinine levels.Methods: A total of 640 LDNs were performed from March 1996 to August 2001. Warm ischemia times were prospectively collected and were defined as the time from renal artery occlusion to immersion in iced saline. Serial recipient creatinine levels were measured at 1 week and 1, 3, 6, and 12 months (when possible) from the transplant. Data were analyzed using Pearson correlation analysis at a confidence interval of 95%.Results: Mean warm ischemia time was 151 s with a standard error of 3.4 s and ranged from 35 to 720 s. Recipient creatinine mean at I week was 1.94 mg/dl with a standard error of 0.06 mg/dl and ranged from 0.5 to 10.5 mg/dl. Recipient creatinine mean at 1 month was 1.68 mg/dl with a standard error of 0.06 mg/dl and ranged from 0.6 to 8.5 mg/dl. Recipient creatinine mean at 3 months was 1.60 mg/dl with a standard error of 0.04 mg/dl and ranged from 0.6 to 8.8 mg/dl. Recipient creatinine mean at 6 months was 1.63 mg/dl with a standard error of 0.06 mg/dl and ranged from 0.7 to 13.5 mg/dl. Recipient creatinine mean at 12 months was 1.70 mg/dl with a standard error of 0.07 mg/dl and ranged from 0.5 to 14.5 mg/dl. No correlation was found between warm ischemia time and recipient creatinine levels at 1 week (p = 0.4737), 1 month (p = 0.9180), 3 months (p = 0.6227), 6 months (p = 0.8349), or 12 months (p = 0.2835).Conclusions: Warm ischemia time does not correlate with recipient graft function in LDN within the range of times studied. Shorter warm ischemia time associated with open donor nephrectomy and hand-assisted LDN does not necessarily offer a measurable advantage in recipient graft function. During extraction of the kidney, expediency to minimize warm ischemia time should not supersede controlled and safe maneuvers in renal vessel division and extraction of the kidney.