Lifeport与静态低温保存应用于器官捐献供肾保存效果的Meta分析

Meta analysis of the effect of Lifeport and static cold storage on donor kidney

目的系统评价Lifeport与静态低温保存(CS)在器官捐献供肾的保存效果。方法计算机检索Medline数据库、Embase数据库、考克兰图书馆(Cochrane library)、中国生物医学文献数据库、中国知网、万方数据库和维普数据库,搜集Lifeport与CS在移植肾保存效果的相关临床研究,检索时限均从建库至2015年12月31日。按照纳入与排除标准选择文献,评价质量并提取资料,并评价纳入研究的偏倚风险后,采用Stata 12软件进行Meta分析。结果共纳入16个研究,包括5个随机对照试验(RCT)和11个回顾性队列研究(RCS)。Meta分析结果显示:与CS组比较,(1)总体捐献供肾(TDD),Lifeport组移植术后移植肾功能延迟恢复(DGF)发生率降低,DGF持续时间减少、平均住院日减少以及术后1年肾存活率增加,两组术后急性排斥反应(AR)发生率与1年人存活率相当;(2)心脏死亡器官捐献供肾(DCD):Lifeport组术后DGF发生率降低,术后平均住院日减少,两组术后移植肾原发性无功能(PNF)与AR发生率,术后1年人、肾存活率比较,差异无统计学意义;(3)扩展标准供肾(ECD):Lifeport组术后PNF发生率降低并改善术后1年肾存活率,两组术后DGF发生率、AR发生率与术后1年人存活率比较,差异无统计学意义。结论 Lifeport应用于器官捐献供肾保存具有一定的优势,但受纳入研究数量及质量所限,上述研究结论尚需开展更多高质量研究予以验证。

Objective To evaluate the effect of Lifeport and static cold storage（ CS） on preservation of donor kidney. Methods Medline,Embase,Cochrane library,CBMdisc,China National Knowledge Infrastructure,Wanfang database and VIP database were searched by computer,and relevant clinical studies on the effect of Lifeport and CS on preservation of transplant kidney were collected,with the search period from database construction to December 31,2015.According to the inclusion and exclusion criteria,relevant references were selected,quality was evaluated,information was extracted,and risk of bias in the study was evaluated. In addition,Meta analysis was conducted using software Stata 12.Results A total of 16 studies were included with 5 randomized controlled trials（ RCT） and 11 retrospective cohort studies（ RCS）. The results of Meta analysis showed that： compared with Group CS,（ 1） for total deceased donor（ TDD）,incidence of delayed graft function（ DGF） decreased in Group Lifeport after transplantation,duration of DGF and average length of stay decreased,and 1-year survival rate of kidney increased after operation. The incidence of postoperative acute rejection（ AR） and 1-year survival rate of patients were similar in two groups.（ 2） for donor after cardiac death（ DCD） ：postoperative incidence of DGF and average length of stay decreased in Group Lifeport; there was no statistical significance inincidence of primary nonfunction（ PNF） and AR,1-year survival rate of kidneys and patients between two groups.（ 3） for expanded criteria donor（ ECD） ： postoperative incidence of PNF decreased and 1-year survival rate of kidney increased in Group Lifeport; there was no statistical significance in postoperative incidence of DGF and AR and 1-year survival rate of kidney between two groups. Conclusions Application of Lifeport in preservation of donor kidney has certain advantages.However,more high-quality studies should be further conducted to verify the study findings due to limited quantity and quality of the study.