心脏死亡供肾中使用机械灌注的保存效果评价

Evaluation of mechanical perfusion preservation of kidneys of donors after cardiac death

目的 探讨心脏死亡器官捐献（DCD）肾移植中使用机械灌注的保存效果。方法 对我院2014年10月~2015年4月收治的68例心脏死亡供肾移植受者资料进行分析,根据不同供肾保存方式,将其分为静态冷储组和机械灌注组,每组有34例,比较两组受者移植肾功能延迟恢复（DGF）发生情况及其早期移植肾功能。结果 机械灌注组的住院时间为（14.15±3.77）d,DGF发生率为14.7%;静态冷储组的住院时间为（16.97±6.13）d,DGF发生率为35.3%,两组比较有显著差异（P〈0.05）;术后1 w内,两组血肌酐、尿素氮总体水平无显著性差异（P〉0.05）;机械灌注组灌注3 h后,阻力系数由开始灌注时的（0.1935±0.0633）mm Hg/（ml·min）下降到（0.1532±0.0697）mm Hg/（ml·min）,流量从（61.71±31.82）ml/min上升到（101.12±28.93）ml/min,2例DCD供肾使用机械灌注中,因供肾病理提示存在化脓性感染灶弃用。结论 机械灌注保存能够降低心脏死亡供肾移植受者DGF发生率,值得推广使用。

Objective To investigate mechanical perfusion preservation effects on kidneys of donors after cardiac death （DCD）. Methods Analysis was made in the data of 68 recipients of DCD for kidney transplantation between of October 2014 and April 2015. According to the different preservation methods of the donor kidneys, those cases were divided into static cold storage group and mechanical perfusion group with 34 ones in each group. Comparison was made in renal delayed graft function （DGF） and its early graft function between the two groups, Results The hospitalization time of the mechanical perfusion group was （14.15±3.77）d, and its incidence of DGF was 14.7%; the hospitalization time of the static cold storage group was （16.97±6.13）d, and its incidence of DGF was 35.3%. The differences between the two groups were significant（P 〈 0.05）. Within 1 w after the operation, there was no significant difference in the overall levels of serum creatinine and urea nitrogen between the two groups （P 〉 0.05）. Three hours after the mechanical perfusion, the drag coefficient decreased from （0.1935±0.0633）mmHg/（ml·min） at the start of the perfusion to （0.1532± 0.0697）mmHg/（ml·min）; the flow increased from （61.71±31.82）ml/min to （101.12±28.93）m1/min. During the mechanical perfusion, 2 cases of DCD kidneys were abandoned due to the pathological prompt of the presence of purulent foci in the donor kidneys. Conclusion Mechanical perfusion preservation can reduce the incidence of DGF in DCD kidney transplantation recipients, which is worthy of promotion.