低温机械灌注对公民逝世后器官捐献供肾的功能维护及质量评估  

Quality evaluation and functional repair of the donated kidneys by machine perfusion

作　　者：宫念樵[1] 明长生[1] 卢峡[1] 蒋继贫[1] 张伟杰[1] 曾凡军[1] 周平[1] 陈刚[1] 林正斌[1] 刘斌[1] 杜敦峰[1] 昌盛[1] 陈栋[1] 朱兰[1] 施辉波[1] 陈松[1] 陈知水[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院器官移植研究所卫生部/教育部器官移植重点实验室,武汉430030

出　　处：《中华器官移植杂志》2016年第8期449-452,共4页Chinese Journal of Organ Transplantation

基　　金：卫生和计划生育委员会2013年公益性卫生行业科研专项（201302009）;国家自然科学基金（81570678）

摘　　要：目的采用LifePort肾脏灌注运转器对公民逝世后器官捐献（DCD）供肾进行低温机械灌注保存，总结低温机械灌注保存法对供肾质量评估和功能维护的意义。方法自2013年1月至2016年8月，共对625例DCD供肾采用静态冷保存后移植（静态冷保存组），同时使用LifePort对119例DCD供肾进行低温机械灌注保存（低温机械灌注组），在以灌注终点时的阻力指数和流量进行质量评估后，对其中105例进行移植。观察和分析两组供肾移植后移植物功能恢复延迟（DGF）发生率、肾功能恢复正常时间、未发生DGF受者的肾功能恢复正常时间、发生DGF受者的肾功能恢复正常时间及原发性移植物无功能（PNF）的发生情况。对部分弃用供肾进行病理分析。结果低温机械灌注组有14例供肾被弃用，弃用率为11．76％（14／119）。低温机械灌注组受者术后DC-F发生率为13．33％（14／105），肾功能恢复正常的时间为（17．7±13．6）d，未发生DGF受者的肾功能恢复正常的时间为（8．1±5．2）d，发生DGF受者的肾功能恢复正常时间为（33．7±16．9）d，有1例术后发生PNF。2例弃用供肾的病理检查结果显示，肾组织严重水肿、90％肾小管坏死、足突少量融合、系膜基质增生并电子致密物沉积。静态冷保存组受者术后DGF发生率为12．8％（80／625），肾功能恢复正常的时间为（18．6±24．5）d，未发生DGF受者的肾功能恢复正常的时间为（5．6±7．3）d，发生DGF受者的肾功能恢复正常时间为（31．1±19．0）d，有1例术后发生PNF。结论低温机械灌注对供肾质量的评估和修复具有一定的意义。低温机械灌注终点时的阻力指数和流量是重要的评估参数，需要结合临床参数共同进行供肾质量的评估。Objective To clarify the quality evaluation and functional repair of donated kidneys of machine perfusion using LifePort kidney transporter machine （LifePort） in the kidneys. Methods During the period from Jan. 2013 to Aug. 2016, 625 kidneys from Chinese donation after citizen death （DCD） were grafted in our institution after static preservation, while 119 DCD kidneys were performed machine perfusion using LifePort among which 105 kidneys were transplanted. The rate of delayed graft function （DGF）, the recovery period of renal function, the recovery period of renal function in DGF-censored cases, the recovery period of renal function of DGF cases, and the occurrence of primary non-function （PNF） were calculated in the two groups of kidneys receiving machine perfusion and static preservation respectively. Pathological analysis was performed in part of discarded kidneys. Results The discarding rate of DCD kidneys receiving machine perfusion was 11. 76%. In the kidneys receiving machine perfusion, the rate of DGF was 13. 33% and the renal function recovery period was （17. 7 ± 13.6） days, while the renal function recovery period of the DGF- censored cases was （8. 1 ± 5. 2） days and the renal function recovery period of the cases undergoing DGF was （33. 7 ± 16. 9） days. PNF occurred in one case. Two discarded kidneys were examined pathologically with the finding of severe edema, 90% tubular necrosis, foot process fusion, mesangial matrix proliferation and electron dense deposits. In the kidneys subject to static preservation, the rate of DGF was 12. 8% and the renal function recovery period was （18. 6 ± 24. 5） days, while the renal function recovery period of the DGF-censored cases was （5. 6 ± 7. 3） days and the renal function recovery period of the cases undergoing DGF was （31. 1 ± 19. 0） days. PNF occurred in one case. Conclusion Machine perfusion is beneficial to quality evaluation and functional repair of CDCD kidneys. Resistant index and flux volume at the end of perf

关 键 词：公民逝世后器官捐献 肾脏 机械灌注 冷保存 肾移植 

分 类 号：R699.2[医药卫生—泌尿科学]