The use of ex-vivo normothermic perfusion for the resuscitation and assessment of human kidneys discarded because of inadequate in situ perfusion.
The use of ex-vivo normothermic perfusion for the resuscitation and assessment of human kidneys discarded because of inadequate in situ perfusion.
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DOI：
10.1186/s12967-015-0691-x
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发表时间：
2015-10-16
影响因子：
7.4
通讯作者：
Nicholson ML
中科院分区：
文献类型：
--
作者：
Hosgood SA;Barlow AD;Dormer J;Nicholson ML
许多肾脏移植时由于原位灌注不足而被排斥，这是因为存在额外的缺血性损伤和微血管血栓形成的风险。本研究描述了使用离体常温灌注（EVNP）的复苏和评估的人肾，被丢弃后，在原位灌注不足。22个人类肾脏被取回，但随后被认为不适合移植，主要是由于原位灌注不足。在静态冷藏一段时间后，在36 °C下用基于含氧红细胞的溶液灌注肾脏60分钟。22个肾脏中有19个（86%）来自DCD供体。在EVNP期间，基于肾脏的宏观外观、肾血流量和尿产生的测量来评估肾脏并评分。肾脏评分从1分（表示损伤最小）到5分（表示损伤最严重）。1- 2个肾脏的EVNP评分为1-2，7个评分为3-4，3个评分为5。与评分1-4的肾脏相比，EVNP评分5的肾脏具有低水平的肾小管功能。他们的灌注参数在EVNP期间没有改善，他们被认为是不可移植的。组织学评价与EVNP参数之间无相关性。EVNP恢复离体功能，并能够评估由于原位灌注不足而拒绝移植的肾脏。
Many kidneys are rejected for transplantation due to inadequate in situ perfusion during organ retrieval because of the risk of additional ischaemic injury and microvasculature thrombosis. This study describes the use of ex vivo normothermic perfusion (EVNP) for the resuscitation and assessment of human kidneys that were discarded after inadequate in situ perfusion. Twenty-two human kidneys were retrieved but then deemed unsuitable for transplantation, primarily due to inadequate in situ perfusion. After a period of static cold storage, kidneys were perfused for 60 min with an oxygenated red cell based solution at 36 °C. Nineteen out of 22 kidneys (86 %) were from DCD donors. During EVNP, kidneys were assessed and scored based on their macroscopic appearance, measures of renal blood flow and urine production. Kidneys were scored from 1 indicating the least injury to 5, indicating the worst. Twelve kidneys had an EVNP score of 1–2, 7 scored 3–4 and 3 kidneys scored 5. The EVNP score 5 kidneys had a low level of tubular function compared to the score 1–4 kidneys. Their perfusion parameters did not improve during EVNP and they were considered non-transplantable. There was no association between the histological evaluation and EVNP parameters. EVNP restores function ex vivo and enables an assessment of kidneys that have been declined for transplantation due to inadequate in situ perfusion.