Mannitol infusion within 15 min of cross-clamp improves living donor kidney preservation.
Mannitol infusion within 15 min of cross-clamp improves living donor kidney preservation.
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DOI：
10.1097/tp.0000000000000154
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发表时间：
2014-10-27
期刊：
影响因子：
6.2
通讯作者：
Chen Y
中科院分区：
文献类型：
--
作者：
Andrews PM;Cooper M;Verbesey J;Ghasemian S;Rogalsky D;Moody P;Chen A;Alexandrov P;Wang HW;Chen Y
光学相干断层扫描（OCT）显示，通过腹腔镜手术获得的活体供肾（LDK）的近曲小管内衬细胞非常肿胀，以响应动脉血管夹闭和用冷保存液冲洗切除的肾脏之间经历的短暂缺血期。由于这种细胞肿胀导致的肾小管损伤导致不同程度的急性肾小管坏死（ATN），这减缓了移植后前2周内供体肾的恢复。为了防止在LDK获取过程中的这种细胞损伤，我们改变了甘露醇静脉内给药的方案（即，12.5或25g）。具体而言，我们将甘露醇给药时间从30分钟缩短至15分钟或更短，然后再夹闭肾动脉。OCT显示，甘露醇给药时间的这种变化保护了人供体近端小管免受常温诱导的细胞肿胀。移植后肾功能恢复的评估表明，用这种改良方案治疗的患者恢复正常肾功能的速度明显快于在夹闭肾动脉前30分钟或更长时间用甘露醇治疗的患者。由于移植后第一周移植物恢复缓慢是长期移植物功能和存活的危险因素，我们认为预处理方案的这种变化将改善接受LDK患者的肾移植。
Optical coherence tomography (OCT) revealed that cells lining proximal convoluted tubules of living donor kidneys (LDKs) procured by laparoscopic procedures were very swollen in response to the brief period of ischemia experienced between the time of arterial vessel clamping and flushing the excised kidney with cold preservation solution. Damage to the tubules as a result of this cell swelling resulted in varying degrees of acute tubular necrosis (ATN) that slowed the recovery of the donor kidneys during the first 2 weeks after their transplantation. To prevent this cell damage during LDK procurement, we changed the protocol for intravenous administration of mannitol (i.e., 12.5 or 25 g) to the donor. Specifically, we reduced the time of mannitol administration from 30 to 15 min or less before clamping the renal artery. OCT revealed that this change in the timing of mannitol administration protected the human donor proximal tubules from normothermic-induced cell swelling. An evaluation of posttransplant recovery of renal function showed that patients treated with this modified protocol returned to normal renal function significantly faster than those treated with mannitol 30 min or more before clamping the renal artery. Because slow graft recovery in the first weeks after transplantation represents a risk factor for long-term graft function and survival, we believe that this change in pretreatment protocol will improve renal transplants in patients receiving LDK.