低温机械灌注在器官捐献供肾移植中的临床效果分析

Clinical analysis of mechanical perfusion in donor after cardiac death kidney transplantation

目的 通过观察低温机械灌注保存器官捐献供肾肾移植的临床效果,探讨采用肾脏灌注转运箱（LifePort）对移植肾功能恢复的影响.方法 回顾性分析郑州人民医院器官移植科自2012年1月至2016年12月期间186例供肾移植的临床资料,其中68例供肾采用LifePort低温机械灌注保存;118例供肾采用静态冷保存.收集并分析两组受者术后肾功能恢复情况,统计原发性移植肾无功能（PNF）、肾功能恢复延迟（DGF）、急性排斥反应、感染等并发症的发生率,以及术后12个月、36个月的受者和移植肾存活率等相关资料.结果 两组受者在性别构成、年龄、血液透析患者百分率、透析时间、体重指数、热缺血时间、冷缺血时间等方面相比较,差异均无统计学意义（P＞0.05）.术后1周静态冷保存组受者血肌酐为（128.7±39.5）μmol/L,低温机械灌注组为（106.1±31.8） μmol/L,差异有统计学意义（t=2.145,P＜0.05）;而受者术后3、6、12、24和36个月血肌酐相比较,差异均无统计学意义（t=1.369,P＞0.05;t=1.697,P＞0.05;t=1.329,P＞0.05;t=1.547,P＞0.05;t=1.698,P＞0.05）.静态冷保存组术后DGF发生率为12.7％,低温机械灌注组为4.4％,差异有统计学意义（t=1.258,P＜0.05）.两组间受者术后急性排斥反应和感染发生率的差异均无统计学意义（P＞0.05）.静态冷保存组术后1年的受者和移植肾存活率分别为98.0％和95.5％,低温机械灌注组术后1年受者和移植肾存活率分别为98.5％和96.5％,静态冷保存组术后3年的受者和移植肾存活率分别为94.2％和92.5％,低温机械灌注组术后3年的受者和移植肾存活率分别为96.1％和94.2％,两组间的差异均无统计学意义（P＞0.05）.结论 应用LifePort对器官捐献供肾进行灌注较静态冷保存能够有效降低DGF的发生率.LifePort灌注时的阻力指数和灌注流量对供肾质量的评估具有重要的参考意义.

Objective To observe the clinical effect of mechanical perfusion preservation kidney transplantation in donor after cardiac death （DCD）,and to explore the effect of mechanical perfusion preservation of DCD on renal function recovery.Methods The clinical data of 186 patients undergoing DCD kidney transplantation from January 2012 to December 2016 were retrospectively analyzed.Sixty-eight DCD donor＆#39;s kidneys were preserved by LifePortpreservation （low temperature mechanical perfusion group）,118 DCD donor＆#39;s kidneys were preserved by static low temperature preservation （static low temperature preservation group）.The renal function recovery,the incidence of primary non-function,delayed graft function and infection,and the survival rate of patients and renal grafts were analyzed.Results There was no significant difference between the two groups in gender,age,hemodialysis ratio,dialysis time,BMI,warm ischemia time and cold ischemia time （P＞0.05）.There was significant difference in creatinine value between the two groups at 1st week （P＜0.05）,but there was no significant difference in creatinine at 3rd,6th,12th,24th and 36th month （P＞0.05）.There was significant difference in the incidence of DGF between two groups （P＜0.05）,but no significant difference in the incidence rate of PNF,AR and infection,and the survival rate of patient and renal graft between two groups （P＞0.05）.There was no significant difference in 1-and 3-year survival rate of the recipients and transplanted kidney between the two groups （P＞0.05）.Conclusion LifePort can significantly reduce the incidence of DGF as compared with static cold preservation.The resistance index and perfusion flow of the LifePort have important significance to assess the renal quality.