Hypothermia - a limiting factor in using warm ischemically damaged kidneys
Hypothermia - a limiting factor in using warm ischemically damaged kidneys
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DOI：
10.1034/j.1600-6143.2001.10405.x
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发表时间：
2001-11-01
影响因子：
8.8
通讯作者：
Kootstra, G
中科院分区：
文献类型：
--
作者：
Brasile, L;Stubenitsky, BM;Kootstra, G
进行了一项研究，以确定扩大热缺血（M）损伤肾脏供体库的限制因素。犬肾脏经30 min WI损伤后，在ViaSpan（4 ℃）中冷藏（CS）18 h，或采用失血代谢支持（EMS）技术（32 ℃）温灌注18 h，或进行两种技术的组合。对侧肾切除后行自体肾移植。在单独WI和CS的肾脏中，平均峰值血清肌酐值为6.3 mg/dL，需要14天才能恢复正常。相比之下，在18小时温灌注期间离体复苏肾代谢的肾脏显示血清化学轻度升高（2.6 mg/dL）。冷灌注18 h后，温灌注3 h可减轻肾损伤，温灌注18 h可消除肾损伤。相反，颠倒顺序与CS以下WI和18小时的温灌注导致的时间依赖性增加的损害。这些结果确定低温是扩大肾脏捐献适应症的主要限制因素。虽然低温是保存心脏跳动供体的基础，但其在WI受损器官中的使用似乎是一个限制因素。
A study was performed to determine the limiting factors to expanding the donor pool with warm ischemically (M) damaged kidneys. Canine kidneys were damaged by 30 min of WI, and then either cold stored (CS) in ViaSpan (4degreesC) for 18h, or warm perfused with exsanguineous metabolic support (EMS) technology (32degreesC) for 18h, or subjected to combinations of both techniques. The kidneys were autotransplanted with contralateral nephrectomy. In kidneys with WI and CS alone, the mean peak serum creatinine value was 6.3 mg/dL and took 14 days to normalize. In contrast, kidneys where renal metabolism was resuscitated ex vivo during 18h of warm perfusion demonstrated mild elevations in the serum chemistries (2.6 mg/dL). The damage in kidneys CS for 18h was ameliorated with 3h of subsequent warm perfusion and eliminated by 18 h of warm perfusion. In contrast, reversing the order with CS following WI and 18h of warm perfusion resulted in a time-dependent increase in damage. These results identify hypothermia as a major limiting factor to expanding indications for kidney donation. While hypothermia represents the foundation of preservation In the heart-beating donor, its use in WI damaged organs appears to represent a limiting factor.