低温机械灌注在移植物功能延迟恢复高危尸体供肾肾移植中的应用  

Application of hypothermic machine perfusion in the renal transplantation from deceased donor with high-risk delayed graft function

作　　者：李杨[1] 田晓辉[1] 丁晨光[1] 陈国振 丁小明[1] 项和立[1] 田普训[1] 郑瑾[1] 胡筱筠 薛武军[1] Li Yang;Tian Xiaohui;Ding Chenguang;Chen Guozhen;Ding Xiaoming;Xiang Heli;Tian Puxun;Zheng Jin;Hu Xiaoyun;Xue Wujun(Department of Renal Transplantation,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China)

机构地区：[1]西安交通大学第一附属医院肾移植科,710061

出　　处：《器官移植》2020年第2期259-264,共6页Organ Transplantation

基　　金：国家自然科学基金(81970668);陕西省科技计划项目(2019JM-116)。

摘　　要：目的探讨低温机械灌注(HMP)在移植物功能延迟恢复(DGF)高危尸体供者(DD)的供肾保存中的临床效果。方法采用前瞻性随机对照实验选取行器官捐献的52例DGF高危供者临床资料。将每例供者的2个供肾随机分为HMP组和静态冷保存(SCS)组(每组52例),HMP组供肾均采用LifePort进行低温机械灌注保存,SCS组供肾采用威斯康星大学保存液(UW液)进行冷保存。比较两组受者移植术后DGF和原发性无功能(PNF)的发生情况,观察两组受者移植肾功能恢复情况,观察肾移植术后1年内受者和移植肾的生存情况。结果HMP组受者DGF发生率为4%(2/52),明显低于SCS组受者的17%(9/52)(P<0.05);HMP组无PNF病例,SCS组有1例受者发生PNF,两组比较差异无统计学意义(P>0.05)。HMP组和SCS组受者移植肾功能恢复时间分别为(7.2±0.6)d和(7.7±1.0)d,差异无统计学意义(P>0.05)。HMP组受者手术当日、术后1 d、术后2 d的尿量均明显多于SCS组受者(均为P<0.05),HMP组术后各时间点的血清肌酐水平均明显低于SCS组(均为P<0.05)。HMP组和SCS组受者术后1年的人、肾存活率分别为98.1%、92.3%和100%、96.2%,差异无统计学意义(均为P>0.05)。结论HMP可显著降低DGF高危DD供肾肾移植术后DGF发生率,而且可促进早期移植肾功能的恢复。Objective To evaluate the clinical effect of hypothermic machine perfusion(HMP)in the storage of renal grafts from deceased donor(DD)with high-risk delayed graft function(DGF).Methods Clinical data of 52 donors with high-risk DGF were collected in this prospective randomized controlled study.Two renal grafts from each donor were randomly divided into the HMP group(n=52)and static cold storage(SCS)group(n=52).In the HMP group,the renal grafts were stored by LifePort under HMP,whereas the renal grafts in the SCS group were preserved in University of Wisconsin solution(UW solution).The incidence of DGF and primary nonfunction(PNF)after renal transplantation was statistically compared between two groups.The recovery of renal graft function,the survival rates of the recipients and renal grafts within postoperative 1 year were observed in two groups.Results The incidence of DGF in the HMP group was 4%(2/52),significantly lower than 17%(9/52)in the SCS group(P<0.05).No PNF was reported in the HMP group and 1 case of PND was noted in the SCS group,the difference was not statistically significant(P>0.05).The recovery time of graft function of the recipients in the HMP and SCS groups were(7.2±0.6)d and(7.7±1.0)d with no statistical significance(P>0.05).In the HMP group,the urine volume of the recipients on the day of operation,postoperative 1 and 2 d was significantly larger than that in the SCS group(all P<0.05).In the HMP group,the levels of serum creatinine at each time point after operation were significantly lower than those in the SCS group(all P<0.05).The 1-year survival rates of the recipient and kidney were 98.1%,92.3%and 100%,96.2%in the HMP and SCS groups with no statistical significance(all P>0.05).Conclusions HMP can significantly reduce the incidence of DGF after renal transplantation from DD with high-risk DGF and promote the early recovery of graft function.

关 键 词：肾移植 尸体供肾 高危 低温机械灌注 静态冷保存 移植物功能延迟恢复 原发性无功能 

分 类 号：R617[医药卫生—外科学]