肾移植 , 机器灌注保存 , 活检

Objective To explore the effectiveness of machine perfusion preservation as a viabilitydetermination method for kidneys from donation after cardiac death（DCD）donors. Methods One of the twokidneys from 20 DCD donors were pumped by LifePort Kidney Transporter，another kidney was preserved by static cold preservation. A resistance ＜0.4 mmHg/（mL·min-1）after a minimum of 6 hours on the perfusion apparatus was considered threshold for utilization and ＞0.5 mmHg/（mL·min-1）was considered for discarding. If resistance was 0.4-0.5 mmHg/（mL·min-1），we referred to clinical data. All histological specimen of the discarded kidneys were assessed by Remuzzi score. Results 12 kidneys on perfusion apparatus were transplanted，with resistances of0.15-0.80 mmHg/（mL·min-1）and flow of 32-168 mL/min，all renal grafts worked immediately. The 12 contralateral kidneys were transplanted，9 functioned immediately and 3 suffered from delayed graft function. The kidneys from 8 donors were discarded，with resistances of 0.44-0.88 mmHg/（mL·min-1），and flow of 28-55 mL/min. 4 donors with discarded kidneys had Remuzzi score ≤3，one of which showed micro-thrombosis and 3 of which showed acutetubular injury.Conclusions Resistance ＜0.4 mmHg/（mL·min-1）is a safe threshold for utilization of the kidneyof DCD donors，but it seems that even when resistance ＞0.5 mmHg/（mL·min-1），some of the kidneys may be transplantable. Pre-implant biopsy should be performed for evaluation of high-risk donors.