Normothermic Ex Vivo Kidney Perfusion Improves Early DCD Graft Function Compared With Hypothermic Machine Perfusion and Static Cold Storage
Normothermic Ex Vivo Kidney Perfusion Improves Early DCD Graft Function Compared With Hypothermic Machine Perfusion and Static Cold Storage
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DOI：
10.1097/tp.0000000000003066
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发表时间：
2020-05-01
期刊：
影响因子：
6.2
通讯作者：
Selzner, Markus
中科院分区：
文献类型：
--
作者：
Urbanellis, Peter;Hamar, Matyas;Selzner, Markus
背景：循环死亡后移植肾更好的保存策略对于改善移植肾功能和增加肾脏供体库是必不可少的。我们比较了连续常温离体肾灌注（NEVKP）与低温缺氧机灌注（HAMP）和静态冷藏（SCS）在猪肾autotransplantationmodel.Methods。猪肾暴露于30分钟的热缺血，然后重新植入后，无论是16小时的SCS，HAMP（LifePort 1.0），或NEVKP autotransplantation前（n = 5每组）。对侧肾脏被切除。结果：与HAMP和SCS相比，NEVKP保存的移植物表现出更快的恢复和更好的功能（平均峰值血清肌酐：3.66 +/- 1.33 mg/dL [术后第1天[（POD 1）]，8.82 +/- 3.17 mg/dL [POD 2]和12.90 +/- 2.19 mg/dL [POD 3]）。与HAMP（13.5 +/- 10.3 mL/min，P = 0.001）和SCS（4.0 +/- 2.6 mL/min，P = 0.001）相比，NEVKP组在POD 3时计算的肌酐清除率（63.6 +/- 19.0 mL/min）显著增加。两个灌注组（NEVKP和HAMP，评分：1-1.5）与SCS（评分：1-3，P = 0.3）相比，POD 8的组织学损伤评分较低，但未达到统计学显著性。结论：NEVKP储存与两种冷保存策略相比显著改善了早期肾功能，尽管HAMP也表现出优于SCS的改善。与传统的低温方法相比，NEVKP可能代表了一种新的、上级的循环死亡肾移植后捐献的保存选择。
Background.Better preservation strategies for the storage of donation after circulatory death grafts are essential to improve graft function and to increase the kidney donor pool. We compared continuous normothermic ex vivo kidney perfusion (NEVKP) with hypothermic anoxic machine perfusion (HAMP) and static cold storage (SCS) in a porcine kidney autotransplantation model.Methods.Porcine kidneys were exposed to 30 minutes of warm ischemia and then reimplanted following either 16 hours of either SCS, HAMP (LifePort 1.0), or NEVKP before autotransplantation (n = 5 per group). The contralateral kidney was removed. Animals were followed for 8 days.Results.Grafts preserved by NEVKP demonstrated improved function with more rapid recovery compared with HAMP and SCS (mean peak serum creatinine: 3.66 +/- 1.33 mg/dL [postoperative d 1 [(POD1)], 8.82 +/- 3.17 mg/dL [POD2], and 12.90 +/- 2.19 mg/dL [POD3], respectively). The NEVKP group demonstrated significantly increased creatinine clearance calculated on POD3 (63.6 +/- 19.0 mL/min) compared with HAMP (13.5 +/- 10.3 mL/min, P = 0.001) and SCS (4.0 +/- 2.6 mL/min, P = 0.001). Histopathologic injury scores on POD8 were lower in both perfused groups (NEVKP and HAMP, score: 1-1.5) compared with SCS (score: 1-3, P = 0.3), without reaching statistical significance.Conclusions.NEVKP storage significantly improved early kidney function compared with both cold preservation strategies, although HAMP also demonstrates improvement over SCS. NEVKP may represent a novel, superior preservation option for donation after circulatory death renal grafts compared with conventional hypothermic methods.