静态冷保存序贯低温机械灌注参数对移植肾短期预后影响  

Prognostic values of parameters from hypothermic machine perfusion after static cold storage on short-term outcomes of kidney transplantation

作　　者：邢添瑛 吴江涛[1] 王琦[1] 李广萍 黄莹[1] 欧彤文[1] Xing Tianying;Wu Jiangtao;Wang Qi;Li Guangping;Huang Ying;Ou Tongwen(Department of Urology,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院泌尿外科,北京100053

出　　处：《中华器官移植杂志》2024年第8期543-549,共7页Chinese Journal of Organ Transplantation

基　　金：首都医科大学宣武医院英才培养计划(YC20220111)。

摘　　要：目的探讨静态冷保存(SCS)序贯低温机械灌注(HMP)参数对移植肾短期预后的影响。方法回顾性分析2023年2月至2023年10月首都医科大学宣武医院157例(包括后期删失6例)符合条件的成人供肾移植受者相关资料及对应供肾机械灌注数据, 根据灌注阻力指数及供肾动脉变异情况进行不同层面的观察比较, 主要观察终点为发生移植肾功能延迟(delayed graft function, DGF)及1个月内肌酐是否降至正常, 次要观察终点为1个月内的最低肌酐值、肌酐下降幅度、肌酐降至最低的时间和肌酐降至正常的时间, 使用单因素和多因素回归分析探讨HMP灌注的参数与术后短期预后的关系。结果 157例受者术前平均肌酐(870.0±283.9)μmol/L, 术后1个月内最低肌酐(118.5±63.5)μmol/L。术后16例(10.2%)受者发生DGF, 10例(6.4%)受者肌酐在术后1个月内未降至正常。1个月内肌酐降至最低的时间为(14.5±7.6)d(范围在3~30 d), 肌酐降至正常的时间为(6.4±5.8)d(范围在1~30 d)。多因素回归分析显示HMP的终末阻力指数是发生DGF(P<0.01)、1个月内肌酐是否降至正常(P=0.001)、肌酐下降幅度(P<0.01)、肌酐降至正常所需时间(P=0.024)的独立影响因素。结论在SCS序贯HMP的供肾保存模式下, HMP的参数对判断肾移植术后短期预后具有应用价值。终末阻力指数是多种预后事件的独立影响因素。ObjectiveTo evaluate the prognostic values of parameters from hypothermic machine perfusion(HMP)after static cold storage(SCS)on short-term outcomes of kidney transplantation.MethodFrom February 2023 to October 2023,the authors retrospectively reviewed the clinical and HMP data of recipients undergoing adult deceased donor kidney transplantation at Xuanwu Hospital,Capital Medical University.HMP resistance and renal arterial anatomical variants were utilized for subgroup analysis.The primary endpoints were delayed graft function(DGF)and whether or not creatine level normalized.The secondary endpoints were the lowest creatine level within 1 month post-kidney transplantation,reduction extent of creatinine level,duration for creatine level to decline to the lowest and duration for creatinine normalization.Single and multiple variable analyses were utilized for examining the correlation between HMP parameters and short-term postoperative outcomes.ResultA total of 157 recipients were included for analysis.Mean serum creatinine level was(870.0±283.9)µmol/L and mean trough creatinine level within 1 month postoperatively(118.5±63.5)µmol/L.Sixteen recipients(10.2%)had delayed graft function(DGF)and creatinine failed to normalize in 10 receipients(6.4%).Average time for creatinine to decline to the lowest level within 1 month was(14.5±7.6)d(3~30 d)and average time for creatinine to normalize(6.4±5.8)d(1~30 d).Multiple variable regression analysis revealed that terminal resistant index was independently correlated with multiple events,including DGF(P<0.01),whether or not creatinine level normalized within 1 month(P=0.001),reduction extent of creatinine level(P<0.01)and duration for creatinine normalization(P=0.024).ConclusionParameters of HMP after SCS are capable of predicting the short-term outcomes of kidney transplantation.Terminal resistant index is an independent risk factor for several prognostic events.

关 键 词：肾移植 器官保存 低温机械灌注 

分 类 号：R699.2[医药卫生—泌尿科学]