Twenty-four-hour normothermic perfusion of discarded human kidneys with urine recirculation
Twenty-four-hour normothermic perfusion of discarded human kidneys with urine recirculation
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DOI：
10.1111/ajt.14932
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发表时间：
2019-01-01
影响因子：
8.8
通讯作者：
Friend, Peter J.
中科院分区：
文献类型：
--
作者：
Weissenbacher, Annemarie;Lo Faro, Letizia;Friend, Peter J.
24 小时或更长时间的可运输常温肾脏灌注可以实现边缘移植物的活力评估、增加器官使用并改善移植物流。 11 个临床衰退的肾脏进行常温灌注，其中 6 个来自脑死亡后的供体（中位冷缺血时间 33 +/- 36.9 小时），5 个来自循环死亡后的供体（36.2 +/- 38.3 小时）。 3个肾脏使用林格氏乳酸盐灌注以替代排泄的尿液量，8个肾脏使用尿液再循环进行灌注以维持灌注液体积而不补充液体。在所有病例中，常温灌注维持或略微改善了组织病理学评估的肾小管状况，并且脑死亡后供体和循环死亡后供体的肾脏均产生有效的尿液（分别为 2367 +/- 1798 mL vs 744.4 +/- 198.4 mL；P = .44）。在灌注液中成功检测到生物标志物、中性粒细胞明胶酶相关脂质运载蛋白和肾损伤分子 1。所有具有尿液再循环的肾脏均易于灌注 24 小时 (n = 8)，并表现出生理性灌流钠水平 (140.7 +/- 1.2 mmol/L)，而无尿液再循环的肾脏 (n = 3) 实现了 7.7 +/- 1.5 小时的常温灌注时间缩短和显着较高的灌流钠水平 (159.6 +/- 4.63 mmol/:, P < .01）。对人体肾脏进行 24 小时常温机器灌注似乎是可行的，并且发现尿液再循环有助于维持灌注液体积和体内平衡。
Transportable normothermic kidney perfusion for 24 hours or longer could enable viability assessment of marginal grafts, increased organ use, and improved transplant logistics. Eleven clinically declined kidneys were perfused normothermically, with 6 being from donors after brain death (median cold ischemia time 33 +/- 36.9 hours) and 5 being from donors after circulatory death (36.2 +/- 38.3 hours). Three kidneys were perfused using Ringer's lactate to replace excreted urine volume, and 8 kidneys were perfused using urine recirculation to maintain perfusate volume without fluid replenishment. In all cases, normothermic perfusion either maintained or slightly improved the histopathologically assessed tubular condition, and there was effective urine production in kidneys from both donors after brain death and donors after circulatory death (2367 +/- 1798 mL vs 744.4 +/- 198.4 mL, respectively; P = .44). Biomarkers, neutrophil gelatinase-associated lipocalin, and kidney injury molecule-1 were successfully detected and quantified in the perfusate. All kidneys with urine recirculation were readily perfused for 24 hours (n = 8) and exhibited physiological perfusate sodium levels (140.7 +/- 1.2 mmol/L), while kidneys without urine recirculation (n = 3) achieved a reduced normothermic perfusion time of 7.7 +/- 1.5 hours and significantly higher perfusate sodium levels (159.6 +/- 4.63 mmol/:, P < .01). Normothermic machine perfusion of human kidneys for 24 hours appears to be feasible, and urine recirculation was found to facilitate the maintenance of perfusate volume and homeostasis.