Ex vivo normothermic perfusion for quality assessment of marginal donor kidney transplants
Ex vivo normothermic perfusion for quality assessment of marginal donor kidney transplants
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DOI：
10.1002/bjs.9894
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发表时间：
2015-10-01
影响因子：
9.6
通讯作者：
Nicholson, M. L.
中科院分区：
文献类型：
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作者：
Hosgood, S. A.;Barlow, A. D.;Nicholson, M. L.
背景：很大一部分用于移植的肾脏由于担心其适用性而被丢弃。本研究采用体外恒温灌注（EVNP）作为肾移植前的质量评估手段。方法74个被认为不适合移植的人肾在取出后，在36℃下用氧合红细胞溶液给予EVNP 60min，用受试者工作特征（ROC）曲线确定肾血流量和尿量的阈值。这些阈值和宏观外观分级被纳入EVNP评估评分（最高质量，1分；最低，5分）。这适用于EVNP后移植的36个肾脏。结果在丢弃肾系列中，1-4分60例（81%），5分14例（19%）。虽然这些肾脏都没有被移植，但那些得分在1到4分之间的肾脏被认为适合移植。在36例移植肾中，评分范围为1 ~ 3分（1、17分；2、11分；3、8分）。所有移植肾脏均无任何并发症或原发性功能障碍。评分1的肾脏移植功能延迟率为6%(17 / 1)，评分2的肾脏移植功能延迟率为0%(11 / 0)，评分3的肾脏移植功能延迟率为38% (8 / 3)（P = 0024）。在评分为1、2和3的肾脏中，12个月肾小球滤过率的平均（s.d）估计分别为51（16）、63（15）和38(21)ml （P = 0015）。结论evnp联合简易评分系统是一种评估移植前肾脏质量和移植可接受性的创新技术。这项研究表明，很高比例的回收肾脏被不必要地丢弃。最大限度地利用肾脏
BackgroundA significant proportion of kidneys procured for transplantation are discarded because of concerns about their suitability. In this study ex vivo normothermic perfusion (EVNP) was used as a quality assessment device before renal transplantation.MethodsSeventy-four human kidneys deemed unsuitable for transplantation following retrieval underwent 60min of EVNP with an oxygenated red cell-based solution at 36 degrees C. Receiver operating characteristic (ROC) curves were used to identify thresholds of renal blood flow and urine output. These thresholds and a grading of macroscopic appearance were incorporated into an EVNP assessment score (highest quality, 1; lowest, 5). This was applied to a series of 36 kidneys transplanted after EVNP.ResultsIn the discarded kidney series, 60 (81 per cent) scored 1-4 and 14 (19 per cent) scored 5. Although none of these kidneys was transplanted, those with a score from 1 to 4 were considered suitable for transplantation. In the 36 transplanted kidneys, the score ranged between 1 and 3 (score 1, 17; score 2, 11; score 3, 8). All of these kidneys were transplanted without any complications or primary non-function. The delayed graft function rate was 6 per cent (1 of 17) in kidneys scoring 1, 0 per cent (0 of 11) in those scoring 2 and 38 per cent (3 of 8) in those scoring 3 (P = 0024). The mean(s.d.) estimated glomerular filtration rate at 12months was 51(16), 63(15) and 38(21) ml in kidneys scoring 1, 2 and 3 respectively (P = 0015).ConclusionEVNP combined with a simple scoring system is an innovative technology for pretransplant assessment of kidney quality and acceptability for transplantation. This study suggests that a high percentage of retrieved kidneys are being discarded unnecessarily.Maximizes kidney use