Protective effect of extracorporeal membrane oxygenation on donor kidneys from non-controllable donation after cardiac death
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摘要:
目的 探讨体外膜肺氧合(ECMO)对非可控型心脏死亡器官捐献(DCD)供肾的保护效果。 方法 随机选取60例非可控型DCD患者,按ECMO体内灌注的时间将60例供体随机分为3组,实验组1利用ECMO灌注2 h,实验组2灌注4 h,实验组3灌注6 h,每组20例,相应受体亦分为3组,每组20例。同时随机选取20例接受循环功能稳定的脑死亡器官捐献(DBD)的受体作为对照组。比较各组受体的移植物功能延迟恢复(DGF)、原发性移植物无功能(PNF)和急性排斥反应的发生率;比较各组受体的移植肾恢复时间、术后第1日尿量和术后1年移植肾功能等指标;比较各组受体术后1年人、肾存活率。 结果 与对照组比较,各实验组受体的PNF、DGF及急性排斥反应发生率的差异均无统计学意义(均为P>0.05)。与对照组比较,各实验组的移植肾功能恢复时间明显延长,差异有统计学意义(均为P < 0.05),而各实验组受体术后第1日尿量及术后1年的肾功能差异均无统计学意义(均为P>0.05)。各实验组及对照组肾移植术后1年的人、肾存活率均为100%,差异均无统计学意义(均为P>0.05)。 结论 利用ECMO技术辅助非可控型DCD的循环或呼吸功能可以很好地保护供肾功能,提高供肾使用率。 -
关键词:
- 肾移植 /
- 体外膜肺氧合(ECMO) /
- 心脏死亡器官捐献(DCD) /
- 移植物功能延迟恢复(DGF) /
- 急性排斥反应 /
- 血尿素氮 /
- 血清肌酐 /
- 原发性移植肾无功能(PNF)
Abstract:Objective To explore the protective effect of extracorporeal membrane oxygenation (ECMO) on donor kidneys from non-controllable donation after cardiac death (DCD). Methods A total of 60 non-controllable DCD donors were selected and divided into 3 groups randomly based on the in vivo perfusion time of ECMO: test group 1 received EMCO perfusion for 2 h, test group 2 for 4 h and test group 3 for 6 h, with 20 cases in each group. Corresponding recipients were also divided into 3 groups, with 20 cases in each group. Meanwhile, 20 recipients from donation after brain death (DBD) with stable circulatory function were randomly selected as control group. Incidence of delayed graft function (DGF), primary graft nonfunction (PNF) and acute rejection of the recipients in different groups was compared. The indexes including graft function recovery time, urine volume on day 1 and graft function within 1 year after renal transplantation were compared for the recipients in different groups. And 1-year survival rate of the recipients and grafts after renal transplantation was compared. Results Compared with the control group, various test groups presented no significant differences in the incidence of PNF, DGF and acute rejection (all P>0.05). Compared with the control group, graft function recovery time prolonged significantly in each test group, which presented statistically significant differences (all P < 0.05), while the urine volume on day 1 and graft function within 1 year after renal transplantation presented no statistically significant difference in each test group (all P>0.05). The 1-year survival rate of the recipients and grafts after renal transplantation was 100% in various test groups and control group, which presented no statistically significant difference (all P>0.05). Conclusions ECMO can protect donor kidneys effectively through assisting the circulatory or respiratory function of non-controllable DCD, and improve their utilization rate. -
表 1 各组受体术后早期并发症发生率的比较
Table 1. Comparison of the incidence of postoperative early complications among each group[n(%)]
组别 n PNF DGF 急性排斥反应 实验组1 20 0 1(5) 6(30) 实验组2 20 0 3(15) 7(35) 实验组3 20 1(5) 2(10) 5(25) 对照组 20 0 2(10) 6(30) 表 2 各组受体术后移植肾功能恢复情况的比较
Table 2. Comparison of the early postoperative graft function among each group (x±s)
组别 n 移植肾功能
恢复正常时间(d)术后第1日
尿量(mL)术后1年
Scr(μmol/L)术后1年
BUN(mmol/L)实验组1 20 9.7±2.3a 3 500±655 90±26 4.5±0.9 实验组2 20 9.9±2.8a 3 450±700 109±29 5.2±1.1 实验组3 20 9.7±2.2a 3 750±725 102±32 5.5±1.2 对照组 20 7.1±2.9 3 650±670 98±30 5.6±1.2 与对照组比较,aP < 0.05 -
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