Experimental renal preservation by normothermic resuscitation perfusion with autologous blood
Experimental renal preservation by normothermic resuscitation perfusion with autologous blood
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DOI：
10.1002/bjs.5909
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发表时间：
2008-01-01
影响因子：
9.6
通讯作者：
Nicholson, M. L.
中科院分区：
文献类型：
--
作者：
Bagul, A.;Hosgood, S. A.;Nicholson, M. L.
背景：常温灌注（NP）具有改善代谢支持和维持缺血损伤器官活力的潜力。本研究在受控无心跳供体（NHBD）肾脏模型中比较NP与当前器官保存方法的效果。（每组n = 6）进行10分钟的热缺血，然后如下保存：分别用冰中冷藏2 h（CS 2组）、18 h（CS 18组）、18 h冷机灌注（CP组）和16 h CS + 2 h NP（NP组）。采用离体器官灌流系统，在自体血再灌注3 h期间测定肾血流动力学和功能。曲线下面积（AUC）444（57）vs 325（70）ml/100 g; P = 0.004），但NP恢复了这一点（563（119）ml/100 g; P = 0.035 vs CS 18）。CS2、CP和NP组的肾功能也优于CS 18组（平均值（s.d.）血清肌酐分别下降92（6）、79（9）和64（17）%对44（13）%; P = 0.001）。CS 2 h的血清肌酐AUC显著低于CS 18 h（平均值（s.d.）1102（2600）对2156（401）μ mol/l. h; P = 0.001），尽管CP和NP组的值与CS2组的值（分别为1354（300）和1756（280）μ mol/l. h）无显著差异。NP 2 h后，3 '-三磷酸腺苷与3 '-二磷酸腺苷的比值显著高于其他各组的灌注前值（P = 0.046）。结论：NP加氧合血能恢复ATP耗竭水平，逆转CS的某些有害作用。
Background: Normothermic perfusion (NP) has the potential to improve metabolic support and maintain the viability of ischaemically damaged organs. This study investigated the effects of NP compared with current methods of organ preservation in a model of controlled non-heart-beating donor (NHBD) kidneys.Methods: Porcine kidneys (n = 6 in each group) were subjected to 10 min warm ischaemia and then preserved as follows: 2 h cold storage (CS) in ice (CS2 group), 18 h CS (CS18 group), 18 h cold machine perfusion (CP group) or 16 h CS + 2 h NP (NP group). Renal haemodynamics and function were measured during 3 h reperfusion with autologous blood using an isolated organ perfusion system.Results: Increasing CS from 2 to 18 h reduced renal blood flow (mean(s.d.) area under the curve (AUC) 444(57) versus 325(70) ml per 100 g; P = 0.004), but this was restored by NP (563(119) ml per 100 g; P = 0.035 versus CS18). Renal function was also better in CS2, CP and NP groups than in the CS18 group (mean(s.d.) serum creatinine fall 92(6), 79(9) and 64(17) versus 44(13) per cent respectively; P = 0.001). The AUC for serum creatinine was significantly lower with CS for 2 h than for 18 h (mean(s.d.) 1102(2600) versus 2156(401) mu mol/l.h; P = 0.001), although values in CP and NP groups were not significantly different from those in the CS2 group (1354(300) and 1756(280) mu molA.h respectively). Two hours of NP increased the adenosine 3 '-triphosphate : adenosine 3 '-diphosphate ratio to a significantly higher level than the preperfusion values in all other groups (P = 0.046).Conclusion: NP with oxygenated blood was able to restore depleted ATP levels and reverse some of the deleterious effects of CS.