肾脏常温机械灌注与无缺血肾移植

Normothermic machine perfusion of kidney and ischemia-free kidney transplantation

为了增加扩大标准供者(ECD)肾脏的利用率,肾脏保存方法近年来在不断发展。常温机械灌注(NMP)的使用,促进了离体供肾保存、评估和修复,以及肾移植手术方式革新。中山大学附属第一医院器官移植中心首创的无缺血肾移植(IFKT)手术,利用肾脏NMP机器在供肾获取、保存、移植全过程中,保持供肾血流和供氧不中断,从根本上避免了供肾缺血-再灌注损伤(IRI),降低了术后移植物功能延迟恢复(DGF)和急性排斥反应发生的风险。本文着重总结肾脏NMP的新进展,以及IFKT手术方式和近期疗效,旨在为提高ECD供肾利用率、解决器官短缺的问题提供参考。

To increase the utilization rate of expanded criteria donor(ECD)kidney,the kidney preservation methods have been ever advancing in recent years.The application of normothermic machine perfusion(NMP)promotes the preservation,evaluation and repair of ex vivo donor kidneys and accelerates the innovation of surgical approaches of kidney transplantation.Ischemia-free kidney transplantation(IFKT),which initiated by Organ Transplantation Center of the First Affiliated Hospital of Sun Yat-sen University,keeps the blood flow and oxygen supply of the donor kidney with NMP machine during the entire process of acquisition,preservation and transplantation,thereby fundamentally avoiding ischemia-reperfusion injury(IRI)of the donor kidney and reducing the risk of delayed graft function(DGF)and acute rejection after surgery.In this article,recent progresses upon the kidney NMP,surgical procedures and short-term outcomes of IFKT were reviewed,aiming to provide reference for enhancing the utilization rate of ECD donor kidney and resolving the issue of organ shortage.