Overcoming severe renal ischemia: The role of ex vivo warm perfusion
Overcoming severe renal ischemia: The role of ex vivo warm perfusion
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DOI：
10.1097/00007890-200203270-00011
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发表时间：
2002-03-27
期刊：
影响因子：
6.2
通讯作者：
Kootstra, G
中科院分区：
文献类型：
--
作者：
Brasile, L;Stubenitsky, BM;Kootstra, G
背景有效利用严重（2小时）热缺血（WI）损伤的肾脏的能力可以提供更多的肾脏移植。本研究的目的是检查在离体温灌注期间使用脱细胞技术恢复严重WI损伤后的肾代谢的效果。热灌注18小时后，将肾脏再次植入并评估移植物功能。使用犬自体移植模型，肾脏暴露于120分钟的WI。然后立即再植入，用Belzer溶液低温机器灌注（4 ℃）18小时，或转移到无细胞灌注液温灌注（32 ℃）18小时。120 min WI热灌注肾可提供移植后的生命维持功能，而对照肾立即回植或低温机器灌注则不能。热灌注肾的平均峰值血清肌酐为3.7 mg/dl，平均峰值出现在移植后第2天，第9天恢复正常。这些结果表明，18小时的离体肾脏温灌注是可行的。此外，温灌注过程中肾功能的恢复被证明，导致移植后立即功能。利用离体热灌注恢复严重缺血性肾功能，为增加可移植肾的数量提供了基础。
Background. The ability to effectively utilize kidneys damaged by severe (2 hr) warm ischemia (WI) could provide increased numbers of kidneys for transplantation. The present study was designed to examine the effect of restoring renal metabolism after severe WI insult during ex vivo warm perfusion using an acellular technology. After warm perfusion for 18 hr, kidneys were reimplanted and evaluated for graft function.Methods. Using a canine autotransplant model, kidneys were exposed to 120 min of WI. They were then either reimplanted immediately, hypothermically machine perfused (4degreesC) for 18 hr with Belzer's solution, or transitioned to 18 hr of warm perfusion (32degreesC) with an acellular perfusate before implantation.Results. Warm perfused kidneys with 120 min of WI provided life-sustaining function after transplantation, whereas the control kidneys immediately reimplanted or with hypothermic machine perfusion did not. The mean peak serum creatinine in the warm perfused kidneys was 3.7 mg/dl, with the mean peak occurring on day 2 and normalizing on day 9 posttransplant.Conclusions. These results indicate that 18 hr of ex vivo warm perfusion of kidneys is feasible. Furthermore, recovery of renal function during warm perfusion is demonstrated, resulting in immediate function after transplantation. The use of ex vivo warm perfusion to recover function in severe ischemically damaged kidneys could provide the basis for increasing the number of transplantable kidneys.