One or 4 h of "in-house" reconditioning by machine perfusion after cold storage improve reperfusion parameters in porcine kidneys
One or 4 h of "in-house" reconditioning by machine perfusion after cold storage improve reperfusion parameters in porcine kidneys
复制标题
DOI：
10.1111/tri.12393
复制
发表时间：
2014-11-01
影响因子：
3.1
通讯作者：
Minor, Thomas
中科院分区：
文献类型：
--
作者：
Gallinat, Anja;Efferz, Patrik;Minor, Thomas
冷藏（低温再处理）后的室内机器灌注已被提出作为改善移植肾功能的方便工具。本研究探讨了机器灌注时间对猪肾早期再灌注参数的作用。在猪离体肾灌注模型中研究了低温保存（4 ℃，18小时）和随后的1小时或4小时的脉动式无氧低温机器灌注（HMP）后的肾功能（分别为n=6），并与简单的冷保存移植物（CS）进行了比较。与单独CS相比，随后1或4小时的HMP在热再灌注后类似且显著地改善肾血流和肾功能（清除率和钠重吸收），沿着灌注液中内皮素-1浓度降低和血管中一氧化氮释放增加。HMP的分子效应包括在CS后1小时HMP结束时已经观察到的内皮转录因子KLF 2的显著（与CS相比）mRNA增加和内皮素表达降低。即使临床后勤仅允许一小时的治疗，冷储存的肾脏的修复也是可能的，而通过内部机器灌注有限地延长整体储存时间也可能使移植从夜间推迟到白天工作。
In-house machine perfusion after cold storage (hypothermic reconditioning) has been proposed as convenient tool to improve kidney graft function. This study investigated the role of machine perfusion duration for early reperfusion parameters in porcine kidneys. Kidney function after cold preservation (4 degrees C, 18h) and subsequent reconditioning by one or 4h of pulsatile, nonoxygenated hypothermic machine perfusion (HMP) was studied in an isolated kidney perfusion model in pigs (n=6, respectively) and compared with simply cold-stored grafts (CS). Compared with CS alone, one or 4h of subsequent HMP similarly and significantly improved renal flow and kidney function (clearance and sodium reabsorption) upon warm reperfusion, along with reduced perfusate concentrations of endothelin-1 and increased vascular release of nitric oxide. Molecular effects of HMP comprised a significant (vs CS) mRNA increase in the endothelial transcription factor KLF2 and lower expression of endothelin that were observed already at the end of one-hour HMP after CS. Reconditioning of cold-stored kidneys is possible, even if clinical logistics only permit one hour of therapy, while limited extension of the overall storage time by in-house machine perfusion might also allow for postponing of transplantation from night to early day work.