低温机械灌注在公民逝世后器官捐献供肾评估及维护中的应用  

Application of hypothermic machine perfnsion in graft evaluation and preservation in renal transplants from donation after citizens death

作　　者：高嘉林[1] 王钢[1] 王伟刚[1] 王远涛[1] 王金国[1] 高宝山[1] 周洪澜[1] 傅耀文[1] 

机构地区：[1]吉林大学第一医院泌尿外二科,长春130021

出　　处：《中华器官移植杂志》2016年第8期453-456,共4页Chinese Journal of Organ Transplantation

基　　金：国家自然科学基金青年基金项目（81501381）;吉林省科技发展计划资助项目（20160101100JC）;吉林省卫生厅课题（20142042）

摘　　要：目的探讨低温机械灌注保存在公民逝世后器官捐献（DCD）供肾评估及维护中的应用，并对移植效果进行分析。方法回顾性分析172例DCD供者供肾移植的临床资料。172例供者成功捐献供肾344例，其中232例供肾应用LifePort进行低温持续灌注保存（LifePort组），112例采用单纯低温保存（对照组）。评估后LifePort组弃用供肾6例，共完成338例肾移植。对两组术后移植肾功能延迟恢复（DGF）发生率、血肌酐水平进行对比分析，分析和探讨LifePort组供肾的机械灌注参数等指标。结果338例受者中术后2例出现原发性移植肾无功能。Lifeport组和对照组术后急性排斥反应发生率分别为12．5％（28／224）和10．7%（12／112）（P=0．76），经抗排斥反应治疗后均逆转。Lifeport组和对照组术后DGF发生率分别为8．5％（19／224）和19．6％（22／112）（P=0．003）。LifePort组受者中，发生DGF受者的供肾终末阻力为（0．31±0．11）mmHg·ml^-1·min^-1，较未发生EGF受者的（0．22±0．07）mmHg·ml^-1·min^-1显著升高（P〈0．01）；发生DGF受者的供肾终末流速为（90．20±21．34ml·min^-1），较未发生DGF受者的（112．68±19．53）ml／min显著降低（P〈0．01）。LifePort组和对照组未发生DGF受者的术后血肌酐恢复至正常的时间分别为（5．2±1．8）d和（7．6±2．4）d（P〈0．01）。Lifeport组和对照组术后第7天血肌酐分别为（107．2±43．3）μmol／L和（165．6±54．8）μmol／L（P〈0．01）。结论低温机械灌注在DCD供肾评估及维护中具有重要作用，应用低温机械灌注进行供肾质量评估过程中，建议结合灌注参数、供者因素及供肾病理情况综合判断，以期提高供肾评估的准确性。Objective To investigate the clinical application of Life_Port kidney transporter machine （LifePort） in graft evaluation as well as preservation in renal transplants from donation after citizen death （DCD）, and analyze the curative effect after renal transplantation. Methods 344 kidney grafts were donated by 172 donors after cardiac death in First Hospital of Jilin University between Aug. 2011 and Mar. 2016. 232 kidney grafts were preserved using LifePort and the remaining 112 grafts by static cold storage. Six kidneys were deprecated after evaluation and 338 transplants were performed eventually. The incidence of delayed graft function （DGF）, and serum creatinine was compared respectively between two groups. The parameters of mechanical perfusion in LiftPort group were analyzed as well Results Among 338 kidney transplants, 336 transplants were performed successfully and primary non-function occurred in 2 cases. 28 cases （12. 5%, 28/224） in LifePort group experienced acute rejection （AR） and 12 cases （10. 7%, 12/112） in control group. The AR rate in two groups was not significantly different （P = 0. 76） and all AR cases were recovered after anti-rejection treatment. DGF occurred in 19 cases （8. 5%, 19/224） of LifePort group and22 cases （19.6%, 22/112） in control group （P= 0. 003）. In LiftPort group, the average final resistance parameter of the graft （0. 31 ± 0. 11 mmHg·ml^-1 ·min^-1 ） in patients who experienced DGF was significantly increased as compare with that （0. 22 ± 0. 07mmHg·ml^-1 ·min^-1） in patients who had not experienced DGF （P〈0. 01）, and the average final flow rate parameter of the graft （90. 20 ± 21.34 ml/min） in patients who experienced DGF was significantly decreased as compared with that （112. 68 ± 19. 53 ml· min^-1） in patients who had not experienced DGF （P〈0. 01）. Among the patients without DGF, as compared with control group （7. 6 ± 2. 4 d）, the recovery time of renal function in LifePort group （5. 2 ± 1.8

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]