Abstract:

Objective To investigate the value of hypothermic continuous perfusion machine（LifePort） on the preservation and evaluation of grafts from expanded criteria donors（ECD）for renal transplantation and the value of the decision for transplantion prognosis. Methods The study included kidneys were procured from 52 ECDs underwent preserved with LifePort in First Hospital of Jilin University. The LifePort perfusion parameters and recipients' clinical data were analyzed retrospectively，such as delayed graft function（DGF）incidence，acute rejection rates，serum creatinine，1-year patient and kidney allograft survival rates. Results Among 104 ECDs kidneys underwent preserved with LifePort，8 kidneys were discarded after evaluation，and 96 kidneys were transplanted with no primary non-function（PNF）. The incidence of acute rejection（AR）was 9.38%（9/96），all AR cases were recovered with anti-rejection treatment. The DGF incidence rate was 17.71%（17/96），all DGF cases were recovered within one month. The average final resistance of the graft in patients who experienced DGF was significantly increased than that in patients with no DGF（P ＜ 0.05）. Inversely，the average final flow rate of the graft in patients with DGF was significantly decreased than that in patients without DGF（P＜0.05）. The follow-up period was rangedfrom 6 to 42 months（the median time was 15 months），the average serum creatinine of all recipients was（113.7± 38.4）μmol/L at 6-months follow-up， 1-year patient and kidney allograft survival rates were 100%. Conclusion LifePort played pivotal role in the preservation and evaluation of ECD grafts in renal transplants， combined with the LifePort perfusion parameters，the system gave assistance in any employ the graft or not，and predicted recipients' prognosis.

摘要：

目的 探讨低温持续机械灌注器（LifePort）在扩大标准供者（expanded criteria donors，ECD） 肾脏的维护与评估中的作用及对移植预后的判断价值。方法 回顾性分析吉林大学第一医院器官移植中 心 52 例 ECD 肾脏应用 LifePort 进行低温持续机械灌注维护的参数指标及实施肾移植的临床资料，对供肾 LifePort 灌注情况及术后移植肾功能延迟恢复（delayed graft function，DGF）的发生率、排斥反应、血肌酐水平、 1 年人 / 肾存活率等情况进行总结和分析。结果 52 例 ECD 供者成功捐献供肾 104 例，全部应用 LifePort 进行灌注维护，评估后弃用供肾 8 例，共完成 96 例肾移植，未出现移植肾原发性无功能（primary nonfunction，PNF）；急性排斥反应（acute rejection，AR）的发生率为 9.38％（9/96），经抗排斥反应治疗后均逆转； 术后 DGF 的发生率为17.71%（17/96），患者均在 1 个月内恢复 ；与无 DGF 组受者相比，发生 DGF 受者的 供肾灌注终末阻力平均值明显增高，差异有统计学意义（P ＜ 0.05）；与无 DGF 组受者相比，发生 DGF 受 者的供肾终末流速平均值显著降低，差异有统计学意义（P ＜ 0.05）；随访 6 ～ 42 个月（中位时间为 15 个月）， 术后 6 个月平均血肌酐值为（113.7±38.4）μmol/L，1 年的人 / 肾存活率均为 100%。结论 LifePort 在 ECD 肾脏维护及评估中具有重要作用，可以帮助决策是否使用供肾，结合灌注维护时参数可预估术后恢复情况。