应用LifePort器官转运器改善肾移植效果的大宗临床研究（附573例报告）

潘晓鸣; 薛武军; 田普训; 丁小明; 项和立; 冯新顺; 燕航; 侯军; 田晓辉; 李杨; 丁晨光

doi:10.3969/j.issn.1674-7445.2018.06.006

应用LifePort器官转运器改善肾移植效果的大宗临床研究（附573例报告）

doi: 10.3969/j.issn.1674-7445.2018.06.006

710061 西安交通大学医学院第一附属医院肾病中心

基金项目:

国家自然科学基金 81400677

西安交通大学第一附属医院重大临床研究项目 XJTU1AF-CRF-2015-005

详细信息

通讯作者:
潘晓鸣，男，1968年生，博士，主任医师，研究方向为器官移植，Email：drpanxiaoming@126.com

中图分类号: R617
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出版历程
- 收稿日期: 2018-08-19
- 网络出版日期: 2021-01-19
- 刊出日期: 2018-11-15

Application of LifePort organ transporter to improve clinical efficacy of renal transplantation: a report of 573 cases

Center of Nephropathy, the First Affiliated Hospital, Medical College of Xi'an Jiaotong University, Xi'an 710061, China

More Information

Corresponding author: Pan Xiaoming, Email:drpanxiaoming@126.com

摘要

摘要: 目的探讨供肾脉冲灌注保存转运器（LifePort）保存心脏死亡器官捐献（DCD）供肾和扩大标准供体（ECD）供肾对肾移植术后受者肾功能恢复的影响。方法回顾性分析466例器官捐献（DCD+ECD）供者和882例肾移植受者围手术期的临床资料。根据供肾保存方式不同，将309例DCD供者的左右两侧肾脏随机分为LifePort（DCD-LP）组（309例）和DCD冷藏组（309例）; 132例ECD供者的双侧供肾全部采用LifePort保存并转运，设为ECD-LP组（264例）。分别观察3组受者术后总体情况、术后早期移植肾功能指标、术后并发症发生情况; 对比观察肾移植术前零点穿刺肾组织病理学检查结果; 比较肾移植术后有否发生移植物功能延迟恢复（DGF）受者的供肾LifePort灌注参数。结果与DCD冷藏组比较，DCD-LP组、ECD-LP组受者的住院时间明显缩短，差异均有统计学意义（均为P < 0.05）。DCD冷藏组、DCD-LP组、ECD-LP组围手术期的人存活率均为100%，肾存活率分别为99.7%、100%、99.2%，差异均无统计学意义（均为P > 0.05）。与DCD冷藏组比较，DCD-LP组、ECD-LP组的DGF发生率明显降低，差异均有统计学意义（均为P < 0.05）。3组受者的术后早期肾功能，急性排斥反应、感染和外科并发症的发生率比较，差异均无统计学意义（均为P > 0.05）。病理学检查结果显示，采用LifePort灌注能明显减轻肾小管的水肿、变性、坏死。发生DGF者的供肾LifePort灌注阻力指数明显高于未发生DGF者，而供肾LifePort灌注流量则明显低于未发生DGF者，差异均有统计学意义（均为P < 0.05）。结论 LifePort能有效改善离体DCD和ECD供肾质量，降低术后DGF发生率，促进移植肾功能恢复，并可在离体肾脏维护及评估中对术后恢复情况作出预判。
- 肾移植 /
- 心脏死亡器官捐献（DCD） /
- 扩大标准供者（ECD） /
- LifePort /
- 器官保存 /
- 移植物功能延迟恢复（DGF） /
- 阻力指数 /
- 灌注流量
Abstract: Objective To evaluate the effect of the preservation of the donor kidneys from donation after cardiac death (DCD) and expanded criteria donor (ECD) by donor kidney pulse perfusion storage transporter (LifePort) on the postoperative recovery of renal function in recipients undergoing renal transplantation. Methods Perioperative clinical data of 466 donors (DCD+ECD) and 882 recipients undergoing renal transplantation were retrospectively analyzed. According to different approaches of kidney preservation, bilateral kidneys of 309 DCD donors were randomly divided into the LifePort group(DCD-LP, n=309) and DCD cold storage group (n=309). All the bilateral kidneys of 132 ECD donors were stored and transported by LifePort and assigned into the ECD-LP group (n=264). The postoperative overall condition, early postoperative renal function indexes and postoperative complications of the recipients were observed among three groups. The pathological findings of renal puncture before renal transplantation were observed in donor kidneys. The LifePort perfusion parameters of the donor kidney were compared between the recipients with and without delayed graft function (DGF) after renal transplantation. Results Compared with the DCD cold storage group, the length of hospital stay was significantly shorter in the DCD-LP and ECD-LP groups (both P < 0.05). The survival rate of the recipients was 100% in three groups. The survival rate of the donor kidney was 99.7%, 100% and 99.2% in the DCD cold storage, DCD-LP and ECD-LP groups, respectively. No statistical difference was observed among three groups (all P > 0.05). Compared with the DCD cold storage group, the incidence of DGF was significantly lower in the DCD-LP and ECD-LP groups (both P < 0.05). Early postoperative renal function, the incidence of acute rejection, infection and surgical complications did not significantly differ among three groups (all P > 0.05). Pathological examination demonstrated that usage of LifePort perfusion could significantly mitigate the edema, degeneration and necrosis of renal tubules. In the recipients with DGF, the LifePort perfusion resistance index of donor kidney was significantly higher, whereas the LifePort perfusion volume of donor kidney was considerably lower than those without DGF (both P < 0.05). Conclusions LifePort can effectively improve the quality of the donor kidney from DCD and ECD in vitro, reduce the incidence of postoperative DGF, promote the recovery of transplanted kidney function and predict the postoperative recovery during the maintenance and evaluation of the isolated kidney.
- Renal transplantation /
- Donation after cardiac death (DCD) /
- Expanded criteria donor (ECD) /
- LifePort /
- Organ preservation /
- Delayed graft function (DGF) /
- Resistance index /
- Perfusion volume

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图 1 3组受者肾移植术后1周内肾功能的比较

Figure 1. Comparison of renal function of recipients within 1 weeks after renal transplantation among 3 groups

下载: 全尺寸图片幻灯片

图 2 肾移植术前零点穿刺供肾病理学图片（HE，×200）

A图为DCD供肾，采用普通冷藏法，示肾小管刷状缘脱落、肾小管损伤及萎缩，弃用；B图为ECD供肾，LifePort灌注8 h后移植，示高血压肾损伤小动脉壁增厚，小管水肿、变性减轻；C图为ECD供肾，LifePort灌注4 h后弃用，示肾小管萎缩；D图为DCD供肾，LifePort灌注4 h后弃用，示肾小球囊周纤维化；E图为ECD供肾，LifePort灌注6 h后弃用，示肾小球硬化，小动脉重度增厚，肾小管空泡颗粒变性；F图为ECD供肾，LifePort灌注8 h后弃用，示肾小球硬化

Figure 2. Pathological images of donor kidney by puncture at zero point before renal transplantation

下载: 全尺寸图片幻灯片

表 1 3组受者术后并发症发生率的比较

Table 1. Comparison of incidences of posttransplant complications in recipients among 3 groups [n(%)]

组别	n	DGF	AR	感染	外科并发症
DCD冷藏组	309	98(31.7)a	29(9.4)	61(19.7)	19(6.1)
DCD-LP组	309	53(17.2)^a	28(9.1)	57(18.4)	18(5.8)
ECD-LP组	264	59(22.3)^a	29(11.0)	55(20.8)	16(6.1)
与DCD冷藏组比较，^aP < 0.05

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