目的:分析低温机械灌注保存扩大标准供者(ECD)供肾对肾移植术后受者移植肾功能早期恢复的影响及移植后随访情况,从而探讨其优势。方法:郑州人民医院器官移植中心2016年1月至2019年1月完成ECD供肾移植120例,采用简单随机化分组将供者一...目的:分析低温机械灌注保存扩大标准供者(ECD)供肾对肾移植术后受者移植肾功能早期恢复的影响及移植后随访情况,从而探讨其优势。方法:郑州人民医院器官移植中心2016年1月至2019年1月完成ECD供肾移植120例,采用简单随机化分组将供者一侧肾脏用LifePort持续低温灌注(LifePort组,n=120),另一侧肾脏使用静态冷保存(冷保存组,n=120),然后进行同种异体肾脏移植手术,观察两组受者术后早期移植肾功能结果、移植物存活率、术后并发症的发生情况。结果:两组受者在术后没有发生DGF的情况下,术后2周左右恢复正常并维持在稳定水平。与冷保存组比较,LifePort组受者血清肌酐(SCr)平均值降低幅度更大,出院时LifePort组SCr均值明显低于低温静态组(114.18±14.40μmol/L vs 133.08±21.79μmol/L,P=0.025)。术后1个月、3个月和6个月、1年时,两组受者的SCr值比较,差异均无统计学意义。术后1年时,LifePort组受者的移植肾存活率为99.2%(119/120),高于低温静态组的97.5%(117/120),但两组差异无统计学意义(P=0.097)。LifePort组受者术后移植肾功能恢复延迟(DGF)发生率明显低于低温静态组(10.8%vs 22.5%,P=0.024)。两组受者术后急性排斥反应、外科并发症及感染等发生率的比较,差异均无统计学意义。结论:LifePort低温机械灌注保存供肾,可以减少供肾缺血再灌注损伤程度,显著降低移植术后DGF发生率,移植术后早期SCr均明显优于低温静态保存的供肾,尤其是对ECD效果更为显著。展开更多
AIM To compare survival of kidney transplants from deceased extended criteria donors(ECD) according to:(1) donor graft histological score; and(2) allocation of high score grafts either to single(SKT) or dual(DKT) tran...AIM To compare survival of kidney transplants from deceased extended criteria donors(ECD) according to:(1) donor graft histological score; and(2) allocation of high score grafts either to single(SKT) or dual(DKT) transplant.METHODS Renal biopsy was performed as part of either a newly adopted DKT protocol, or of surveillance protocol in the past. A total 185 ECD graft recipients were categorized according to pre-implantation graft biopsy into 3 groups: SKT with graft score 1 to 4 [SKT(1-4), n = 102]; SKT with donor graft score 5 to 8 [SKT(> 4), n = 30]; DKT with donor graft score 5 to 7(DKT, n = 53). Graft and patient survival were analyzed by Kaplan-Meier curves and compared by log-rank test. Mean number of functioning graft years by transplant reference, and mean number of dialysis-free life years by donor reference in recipients were also calculated at 1, 3 and 6 years from transplantation. RESULTS There were no statistically significant differences in graft and patient survival between SKT(1-4) and SKT(> 4), and between SKT(> 4) and DKT. Recipient renal function(plasma creatinine and creatinine clearance) at 1 years did not differ in SKT(1-4) and SKT(> 4)(plasma creatinine 1.71 ± 0.69 and 1.69 ± 0.63 mg/dL; creatinine clearance 49.6 + 18.5 and 52.6 + 18.8 m L/min, respectively); DKT showed statistically lower plasma creatinine(1.46 ± 0.57, P < 0.04) but not different creatinine clearance(55.4 + 20.4). Due to older donor age in the DKT group, comparisons were repeated in transplants from donors older than 70 years, and equal graft and patient survival in SKT and DKT were confirmed. Total mean number of functioning graft years by transplant reference at 1, 3 and 6 post-transplant years were equal between the groups, but mean number of dialysis-free life years by donor reference were significantly higher in SKT(mean difference compared to DKT at 6 years: 292 [IQR 260-318] years/100 donors in SKT(1-4) and 292.5 [(IQR 247.8-331.6) in SKT(> 4)]. CONCLUSION In transplants from clinically suitable ECD donors, graft展开更多
文摘目的:分析低温机械灌注保存扩大标准供者(ECD)供肾对肾移植术后受者移植肾功能早期恢复的影响及移植后随访情况,从而探讨其优势。方法:郑州人民医院器官移植中心2016年1月至2019年1月完成ECD供肾移植120例,采用简单随机化分组将供者一侧肾脏用LifePort持续低温灌注(LifePort组,n=120),另一侧肾脏使用静态冷保存(冷保存组,n=120),然后进行同种异体肾脏移植手术,观察两组受者术后早期移植肾功能结果、移植物存活率、术后并发症的发生情况。结果:两组受者在术后没有发生DGF的情况下,术后2周左右恢复正常并维持在稳定水平。与冷保存组比较,LifePort组受者血清肌酐(SCr)平均值降低幅度更大,出院时LifePort组SCr均值明显低于低温静态组(114.18±14.40μmol/L vs 133.08±21.79μmol/L,P=0.025)。术后1个月、3个月和6个月、1年时,两组受者的SCr值比较,差异均无统计学意义。术后1年时,LifePort组受者的移植肾存活率为99.2%(119/120),高于低温静态组的97.5%(117/120),但两组差异无统计学意义(P=0.097)。LifePort组受者术后移植肾功能恢复延迟(DGF)发生率明显低于低温静态组(10.8%vs 22.5%,P=0.024)。两组受者术后急性排斥反应、外科并发症及感染等发生率的比较,差异均无统计学意义。结论:LifePort低温机械灌注保存供肾,可以减少供肾缺血再灌注损伤程度,显著降低移植术后DGF发生率,移植术后早期SCr均明显优于低温静态保存的供肾,尤其是对ECD效果更为显著。
文摘AIM To compare survival of kidney transplants from deceased extended criteria donors(ECD) according to:(1) donor graft histological score; and(2) allocation of high score grafts either to single(SKT) or dual(DKT) transplant.METHODS Renal biopsy was performed as part of either a newly adopted DKT protocol, or of surveillance protocol in the past. A total 185 ECD graft recipients were categorized according to pre-implantation graft biopsy into 3 groups: SKT with graft score 1 to 4 [SKT(1-4), n = 102]; SKT with donor graft score 5 to 8 [SKT(> 4), n = 30]; DKT with donor graft score 5 to 7(DKT, n = 53). Graft and patient survival were analyzed by Kaplan-Meier curves and compared by log-rank test. Mean number of functioning graft years by transplant reference, and mean number of dialysis-free life years by donor reference in recipients were also calculated at 1, 3 and 6 years from transplantation. RESULTS There were no statistically significant differences in graft and patient survival between SKT(1-4) and SKT(> 4), and between SKT(> 4) and DKT. Recipient renal function(plasma creatinine and creatinine clearance) at 1 years did not differ in SKT(1-4) and SKT(> 4)(plasma creatinine 1.71 ± 0.69 and 1.69 ± 0.63 mg/dL; creatinine clearance 49.6 + 18.5 and 52.6 + 18.8 m L/min, respectively); DKT showed statistically lower plasma creatinine(1.46 ± 0.57, P < 0.04) but not different creatinine clearance(55.4 + 20.4). Due to older donor age in the DKT group, comparisons were repeated in transplants from donors older than 70 years, and equal graft and patient survival in SKT and DKT were confirmed. Total mean number of functioning graft years by transplant reference at 1, 3 and 6 post-transplant years were equal between the groups, but mean number of dialysis-free life years by donor reference were significantly higher in SKT(mean difference compared to DKT at 6 years: 292 [IQR 260-318] years/100 donors in SKT(1-4) and 292.5 [(IQR 247.8-331.6) in SKT(> 4)]. CONCLUSION In transplants from clinically suitable ECD donors, graft
