Practical Journal of Organ Transplantation(Electronic Version) ›› 2013, Vol. 1 ›› Issue (4): 221-225.

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Role of machine perfusion for evaluation of the viability of kidneys from cardiac death donor

YUAN Xiao-peng,ZHOU Jian,CHEN Chuan-bao,HAN Ming,WANG Xiao-ping,JIAO Xing-yuan,HEXiao-shun.
  

  1. Third Division of Organ Transplant Center,HuangpuDivision of First Affiliated Hospital,SunYat-Sen University,Guangzhou510700,Guangdong,China
  • Online:2013-07-20 Published:2021-04-27

机器灌注保存在评价无心跳供体供肾质量中的作用

袁小鹏,周健,陈传宝,韩明,王小平,焦兴元,何晓顺
  

  1. 中山大学附属第一医院黄埔院区器官移植三区,广东 广州 510700
  • 基金资助:

    国家高技术研究发展计划(863)项目(2012AA021008);

    国家高技术研究发展计划(863)项目(2012AA021008);

    卫生部部属(管)医院临床学科重点项目(2010159);

    国家自然科学基金面上项目(30972951,81170448);

    公益性行业科研专项基金(201002004);

    广东省科技计划临床医学重点项目(2011A030400005)

Abstract:

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.

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摘要:

目的 探讨机器脉冲灌注保存供肾在评估无心跳供体肾脏质量中的作用。方法 20 例无心 跳供体,采用机器(LifePort)低温脉冲灌注保存一侧供肾,阻力系数<0.4 mmHg/(mL·min-1)时认为供 肾可供移植,阻力系数>0.5 mmHg/(mL·min-1)则丢弃供肾,阻力系数 0.4~0.5 mmHg/(mL·min-1)之 间根据临床资料判断。丢弃肾脏均进行病理检查,并行 Remuzzi 评分。结果 12 例机器灌注供肾用于移 植,阻力系数为 0.15~0.80 mmHg/(mL·min-1),灌注流量为 32~168 mL/min,所有供肾移植后功能立 即恢复 12 例对侧供肾移植后中 9 例立即恢复,3 例发生移植肾功能延迟恢复(DGF)。8 例供体丢弃供 肾,灌注阻力系数为 0.44~0.88 mmHg/(mL·min-1),灌注流量为 28~55 mL/min8 例丢弃供肾病理分析 显示,4 例Remuzzi 评分≤3 分,其中 1 例为血栓成,3 例仅为急性肾小管坏死。结论 采用阻力系数< 0.4 mmHg/(mL·min-1)的标准判断供肾质量安全性良好,但是部分阻力系数>0.5 mmHg/(mL·min-1)的 供肾仍然可供移植,需根据穿刺病理分析综合判断。

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