TY - JOUR
T1 - 国内首例人弃肾长时间体外常温机械灌注经验探索
AU - Yang, Huang
AU - Shuangjin, Yu
AU - Haiwei, Chen
AU - Guobin, Wu
AU - Fangze, Qi
AU - Yanhan, Liu
AU - Yuying, Yang
AU - Tong, Chen
AU - Hehuan, Ruan
AU - Tao, Zhang
AU - Honghui, Chen
AU - Chuanbao, Chen
AU - Qiang, Zhao
AU - Zhiyong, Guo
AU - Guodong, Chen
AU - Jiang, Qiu
AU - Xiaoshun, He
N1 - Funding Information:
appearanceofrenalwaspinkandexvivonormothermicperfusionassessmentscore(EVNP)wasgradeⅠ. While,thesixthhourandbeyondofNMP,theappearanceofkidneyturnedtodarkredandEVNPwas gradeⅢ.Therenalperfusionbloodflowmaintainedabove150ml/mininthefirst6hoursand decreasedsignificantlyafterthat,andattheend,wasonly50ml/min.Duringthewholeprocessof perfusion,urineoutputwasmaintainedatabout100ml/h.PO2remainedabove100mmHginthefirst5 hours of perfusion and from the 6th hour, was lower than 80 mmHg and continued to decline, and was closeto0attheendofperfusion.TheresultsshowedthatalthoughtheK+concentrationchangesin bloodandurineinthefirst5hoursofNMPhadagoodconsistency,thelacticacidlevelhadbeen rising.Inaddition,therewasnosignificantchangeinthehistopathologyatthefourthhourofperfusion compared with that before zero⁃point puncture, and the fibrinous thrombus in glomeruli was improved comparedwiththatbeforeperfusion.However,atthesixthhourafterperfusionandbeforetheendof perfusion,thepathologicalchangesofrenaltissueweresignificantlyworse.Therewerealargeof thrombosisinglomerularbloodvessels,renaltubularatrophyandacutetubularnecrosis. Conclusions NMPcanrealizetheevaluationofextendedcriteriadonorsbeforetransplantation,and itprovesthefeasibilityandrepairpotentialofNMPinkidneytoacertainextent.Atthesametime, NMP also provides a new way to expand the source of donor kidney and to pre⁃treat organ in vitro. 【 Key words 】 Kidneytransplantation; Hemoperfusion; Organpreservation; Normothermic machineperfusion;Extendedcriteriadonors Fund programs: National Natural Science Foundation of China (81871257); Natural Science Foundation of Guangdong Province (2016A030313190, 2018A030313612); Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology (2013A061401007, 2017B030314018, 2020B1212060026) DOI: 10 .3760/cma.j.cn441217⁃20210517⁃00047
Publisher Copyright:
© 2022 Chinese Medical Journals Publishing House Co.Ltd. All rights reserved.
PY - 2022
Y1 - 2022
N2 - Objective To explore the long ⁃ term preservation value and repair effect of normothermic machine perfusion (NMP) on clinically discarded kidneys. Methods A case of clinical discarded donor kidney was collected, and NMP was carried out in vitro for 9 hours with recovered blood. The dynamic changes of renal appearance, blood gas and biochemistry analysis of perfusate and renal pathology were recorded. Results In the second to fifth hour of NMP, the appearance of renal was pink and ex vivo normothermic perfusion assessment score (EVNP) was grade Ⅰ. While, the sixth hour and beyond of NMP, the appearance of kidney turned to dark red and EVNP was grade Ⅲ. The renal perfusion blood flow maintained above 150 ml/min in the first 6 hours and decreased significantly after that, and at the end, was only 50 ml/min. During the whole process of perfusion, urine output was maintained at about 100 ml/h. PO2 remained above 100 mmHg in the first 5 hours of perfusion and from the 6th hour, was lower than 80 mmHg and continued to decline, and was close to 0 at the end of perfusion. The results showed that although the K+ concentration changes in blood and urine in the first 5 hours of NMP had a good consistency, the lactic acid level had been rising. In addition, there was no significant change in the histopathology at the fourth hour of perfusion compared with that before zero⁃point puncture, and the fibrinous thrombus in glomeruli was improved compared with that before perfusion. However, at the sixth hour after perfusion and before the end of perfusion, the pathological changes of renal tissue were significantly worse. There were a large of thrombosis in glomerular blood vessels, renal tubular atrophy and acute tubular necrosis. Conclusions NMP can realize the evaluation of extended criteria donors before transplantation, and it proves the feasibility and repair potential of NMP in kidney to a certain extent. At the same time, NMP also provides a new way to expand the source of donor kidney and to pre⁃treat organ in vitro.
AB - Objective To explore the long ⁃ term preservation value and repair effect of normothermic machine perfusion (NMP) on clinically discarded kidneys. Methods A case of clinical discarded donor kidney was collected, and NMP was carried out in vitro for 9 hours with recovered blood. The dynamic changes of renal appearance, blood gas and biochemistry analysis of perfusate and renal pathology were recorded. Results In the second to fifth hour of NMP, the appearance of renal was pink and ex vivo normothermic perfusion assessment score (EVNP) was grade Ⅰ. While, the sixth hour and beyond of NMP, the appearance of kidney turned to dark red and EVNP was grade Ⅲ. The renal perfusion blood flow maintained above 150 ml/min in the first 6 hours and decreased significantly after that, and at the end, was only 50 ml/min. During the whole process of perfusion, urine output was maintained at about 100 ml/h. PO2 remained above 100 mmHg in the first 5 hours of perfusion and from the 6th hour, was lower than 80 mmHg and continued to decline, and was close to 0 at the end of perfusion. The results showed that although the K+ concentration changes in blood and urine in the first 5 hours of NMP had a good consistency, the lactic acid level had been rising. In addition, there was no significant change in the histopathology at the fourth hour of perfusion compared with that before zero⁃point puncture, and the fibrinous thrombus in glomeruli was improved compared with that before perfusion. However, at the sixth hour after perfusion and before the end of perfusion, the pathological changes of renal tissue were significantly worse. There were a large of thrombosis in glomerular blood vessels, renal tubular atrophy and acute tubular necrosis. Conclusions NMP can realize the evaluation of extended criteria donors before transplantation, and it proves the feasibility and repair potential of NMP in kidney to a certain extent. At the same time, NMP also provides a new way to expand the source of donor kidney and to pre⁃treat organ in vitro.
KW - Extended criteria donors
KW - Hemoperfusion
KW - Kidney transplantation
KW - Normothermic machine perfusion
KW - Organ preservation
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U2 - 10.3760/cma.j.cn441217-20210525-00047
DO - 10.3760/cma.j.cn441217-20210525-00047
M3 - Article
AN - SCOPUS:85174499761
SN - 1001-7097
VL - 38
SP - 329
EP - 335
JO - Chinese Journal of Nephrology
JF - Chinese Journal of Nephrology
IS - 4
ER -