Renal Resistance Trend During Hypothermic Machine Perfusion Is More Predictive of Postoperative Outcome Than Biopsy Score: Preliminary Experience in 35 Consecutive Kidney Transplantations
Renal Resistance Trend During Hypothermic Machine Perfusion Is More Predictive of Postoperative Outcome Than Biopsy Score: Preliminary Experience in 35 Consecutive Kidney Transplantations
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DOI：
10.1111/aor.13117
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发表时间：
2018-07-01
影响因子：
2.4
通讯作者：
Socci, Carlo
中科院分区：
文献类型：
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作者：
Bissolati, Massimiliano;Gazzetta, Paolo Giovanni;Socci, Carlo
低温机器灌注（HPM）赠款扩展标准供体（ECD）和心源性死亡后供体（DCD）器官移植的术后效果。到目前为止，关于这些器官的结果预测的唯一可用参数是移植前活检评分。本研究的目的是评估HPM期间肾阻力（RR）趋势是否可用作移植后结局的预测指标。从2015年12月至今，HMP已系统地应用于来自ECD和DCD的所有器官。所有移植物进行移植前活检评估使用Karpinski的组织学评分。只有在灌注3小时内达到RR值1.0的器官才被移植。根据活检评分结果行单肾移植（SKT）或双肾移植（DKT）。进行了65例HMP（58例来自ECD，7例来自DCD/ECMO供体）。15个肾脏修复不充分（RR>1），因此丢弃。移植了49个肾脏，分为21个SKT和14个DKT。总的原发性无功能（PNF）和延迟移植物功能（DGF）率分别为2.9%和17.1%。DGF在DCD的肾脏中更常见（67 vs. 7%; P=0.004）。活检评分与PNF/DGF率（P=0.870）和术后肌酐趋势（P=0.796）无关。在HMP 1小时内达到RR 1.0的肾脏受体具有较低的PNF/DGF率（11 vs. 44%; P=0.033）和更快的血清肌酐降低（POD 10肌酐：1.79 mg/dL vs. 4.33 mg/dL; P=0.019）。RR趋势比活检评分更能预测移植后结局。因此，在器官移植前评估中应考虑RR趋势。
Hypothermic machine perfusion (HPM) grants a better postoperative outcome in transplantation of organs procured from extended criteria donors (ECDs) and donors after cardiac death (DCD). So far, the only available parameter for outcome prediction concerning those organs is pretransplant biopsy score. The aim of this study is to evaluate whether renal resistance (RR) trend during HPM may be used as a predictive marker for post-transplantation outcome. From December 2015 to present, HMP has been systematically applied to all organs from ECDs and DCD. All grafts underwent pretransplantation biopsy evaluation using Karpinski's histological score. Only organs that reached RR value 1.0 within 3 hours of perfusion were transplanted. Single kidney transplantation (SKT) or double kidney transplantation (DKT) were performed according to biopsy score results. Sixty-five HMPs were performed (58 from ECDs and 7 from DCD/ECMO donors). Fifteen kidneys were insufficiently reconditioned (RR>1) and were therefore discarded. Forty-nine kidneys were transplanted, divided between 21 SKT and 14 DKT. Overall primary nonfunction (PNF) and delayed graft function (DGF) rate were 2.9 and 17.1%, respectively. DGF were more common in kidneys from DCD (67 vs. 7%; P=0.004). Biopsy score did not correlate with PNF/DGF rate (P=0.870) and postoperative creatinine trend (P=0.796). Recipients of kidneys that reached RR1.0 within 1 hour of HMP had a lower PNF/DGF rate (11 vs. 44%; P=0.033) and faster serum creatinine decrease (POD10 creatinine: 1.79 mg/dL vs. 4.33 mg/dL; P=0.019). RR trend is more predictive of post-transplantation outcome than biopsy score. Hence, RR trend should be taken into account in the pretransplantation evaluation of the organs.