Normothermic Machine Perfusion and Normothermic Regional Perfusion of DCD Kidneys Before Transplantation: A Systematic Review.

IF 5.3 2区医学 Q1 IMMUNOLOGY

Transplantation Pub Date : 2024-07-18 DOI:10.1097/TP.0000000000005132

Rowan Klein Nulend, Ahmer Hameed, Animesh Singla, Lawrence Yuen, Taina Lee, Peter Yoon, Chris Nahm, Germaine Wong, Jerome Laurence, Wai H Lim, Wayne J Hawthorne, Henry Pleass

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引用次数: 0

Abstract

Background: To overcome organ shortages, donation after circulatory death (DCD) kidneys are being increasingly used for transplantation. Prior research suggests that DCD kidneys have inferior outcomes compared with kidneys donated after brain death. Normothermic machine perfusion (NMP) and normothermic regional perfusion (NRP) may enhance the preservation of DCD kidneys and improve transplant outcomes. This study aimed to review the evidence surrounding NMP and NRP in DCD kidney transplantation.

Methods: Two independent reviewers conducted searches for all publications reporting outcomes for NMP and NRP-controlled DCD kidneys, focusing on delayed graft function, primary nonfunction, graft function, graft survival, and graft utilization. Weighted means were calculated for all relevant outcomes and controls. Formal meta-analyses could not be conducted because of significant heterogeneity.

Results: Twenty studies were included for review (6 NMP studies and 14 NRP studies). Delayed graft function rates seemed to be lower for NRP kidneys (24.6%) compared with NMP kidneys (54.3%). Both modalities yielded similar outcomes with respect to primary nonfunction (NMP 3.3% and NRP 5.6%), graft function (12-mo creatinine 149.3 μmol/L for NMP and 129.9 μmol/L for NRP), and graft utilization (NMP 83.3% and NRP 89%). Although no direct comparisons exist, our evidence suggests that both modalities have good short- and medium-term graft outcomes and high graft survival rates.

Conclusions: Current literature demonstrates that both NMP and NRP are feasible strategies that may increase donor organ utilization while maintaining acceptable transplant outcomes and likely improved outcomes compared with cold-stored DCD kidneys. Further research is needed to directly compare NRP and NMP outcomes.

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DCD 肾移植前的常温机器灌注和常温区域灌注：系统回顾。

背景：为解决器官短缺问题，循环死亡后捐献（DCD）的肾脏正越来越多地被用于移植。先前的研究表明，与脑死亡后捐献的肾脏相比，循环死亡后捐献的肾脏效果较差。常温机器灌注（NMP）和常温区域灌注（NRP）可加强DCD肾脏的保存并改善移植结果。本研究旨在回顾DCD肾移植中NMP和NRP的相关证据：两名独立审稿人检索了所有报道 NMP 和 NRP 控制 DCD 肾脏结果的出版物，重点关注延迟移植物功能、原发性无功能、移植物功能、移植物存活率和移植物利用率。计算了所有相关结果和对照组的加权平均值。由于存在显著的异质性，因此无法进行正式的荟萃分析：共纳入 20 项研究进行审查（6 项 NMP 研究和 14 项 NRP 研究）。与 NMP 肾脏（54.3%）相比，NRP 肾脏（24.6%）的移植功能延迟率似乎较低。在原发性无功能（NMP 3.3% 和 NRP 5.6%）、移植物功能（NMP 12 个月肌酐为 149.3 μmol/L，NRP 12 个月肌酐为 129.9 μmol/L）和移植物利用率（NMP 83.3% 和 NRP 89%）方面，两种方式的结果相似。虽然没有直接的比较，但我们的证据表明，这两种方式都具有良好的中短期移植物疗效和较高的移植物存活率：目前的文献表明，NMP 和 NRP 都是可行的策略，可以提高供体器官的利用率，同时保持可接受的移植结果，而且与冷藏的 DCD 肾脏相比，可能会改善移植结果。还需要进一步的研究来直接比较 NRP 和 NMP 的结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplantation 医学-免疫学

CiteScore

8.50

自引率

11.30%

发文量

1906

审稿时长

1 months

期刊介绍： The official journal of The Transplantation Society, and the International Liver Transplantation Society, Transplantation is published monthly and is the most cited and influential journal in the field, with more than 25,000 citations per year. Transplantation has been the trusted source for extensive and timely coverage of the most important advances in transplantation for over 50 years. The Editors and Editorial Board are an international group of research and clinical leaders that includes many pioneers of the field, representing a diverse range of areas of expertise. This capable editorial team provides thoughtful and thorough peer review, and delivers rapid, careful and insightful editorial evaluation of all manuscripts submitted to the journal. Transplantation is committed to rapid review and publication. The journal remains competitive with a time to first decision of fewer than 21 days. Transplantation was the first in the field to offer CME credit to its peer reviewers for reviews completed. The journal publishes original research articles in original clinical science and original basic science. Short reports bring attention to research at the forefront of the field. Other areas covered include cell therapy and islet transplantation, immunobiology and genomics, and xenotransplantation.