The Value of Machine Perfusion Perfusate Biomarkers for Predicting Kidney Transplant Outcome
The Value of Machine Perfusion Perfusate Biomarkers for Predicting Kidney Transplant Outcome
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DOI：
10.1097/tp.0b013e3181f5c40c
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发表时间：
2010-11-15
期刊：
影响因子：
6.2
通讯作者：
Ploeg, Rutger J.
中科院分区：
文献类型：
--
作者：
Moers, Cyril;Varnav, Oana C.;Ploeg, Rutger J.
背景。回顾性证据表明，在肾机灌注（MP）期间测定乳酸脱氢酶、天冬氨酸转氨酶、总谷胱甘肽- s -转移酶（GST）、丙氨酸-氨基肽酶、n -乙酰- β - d -氨基葡萄糖酶（NAG）和心脏型脂肪酸结合蛋白（H-FABP）对移植后预后具有预测价值。然而，由于基于生物标志物测量的器官丢弃，这些数据可能存在偏差，并且先前的分析没有针对可能的混杂因素进行调整。到目前为止还没有可靠的前瞻性证据。尽管如此，一些中心已经使用这些生物标记来帮助决定接受或丢弃供体肾脏。在一项国际随机对照试验中，对306例脑死亡或心脏死亡后捐献的肾脏进行了这六种生物标志物的测定。在这个未选择的前瞻性数据集中，我们测试了浓度是否与移植物延迟功能、原发性无功能和移植物存活相关。多变量回归模型研究了在校正相关混杂因素后，生物标志物是否仍然是独立的预测因子。GST、NAG和H-FABP是延迟移植物功能的独立预测因子，但不是原发性无功能和移植物存活的独立预测因子。乳酸脱氢酶、天冬氨酸转氨酶和丙氨酸-氨基肽酶在任何终点都没有独立的预后潜力。灌注物生物标志物浓度与冷缺血时间和肾血管对泵的阻力无相关性。MP期间GST、NAG或H-FABP浓度升高是调整移植后受体管理的指征。然而，这项研究首次表明，灌注物生物标志物测量不应导致肾脏丢弃。
Background. Retrospective evidence suggests that lactate dehydrogenase, aspartate aminotransferase, total glutathione-S-transferase (GST), alanine-aminopeptidase, N-acetyl-beta-D-glucosaminidase (NAG), and heart-type fatty acid binding protein (H-FABP) measured during kidney machine perfusion (MP) could have predictive value for posttransplant outcome. However, these data may be biased due to organ discard based on biomarker measurements, and previous analyses were not adjusted for likely confounding factors. No reliable prospective evidence has been available so far. Nevertheless, some centers already use these biomarkers to aid decisions on accepting or discarding a donor kidney.Methods. From 306 deceased-donor kidneys donated after brain death or controlled cardiac death and included in an international randomized controlled trial, these six biomarkers were measured in the MP perfusate. In this unselected prospective data set, we tested whether concentrations were associated with delayed graft function, primary nonfunction, and graft survival. Multivariate regression models investigated whether the biomarkers remained independent predictors when adjusted for relevant confounding factors.Results. GST, NAG, and H-FABP were independent predictors of delayed graft function but not of primary nonfunction and graft survival. Lactate dehydrogenase, aspartate aminotransferase, and alanine-aminopeptidase had no independent prognostic potential for any of the endpoints. Perfusate biomarker concentrations had no relevant correlation with cold ischemic time or renal vascular resistance on the pump.Conclusions. Increased GST, NAG, or H-FABP concentrations during MP are an indication to adjust posttransplant recipient management. However, this study shows for the first time that perfusate biomarker measurements should not lead to kidney discard.