Luccas Marcolin Miranda, Pedro Emanuel Carneiro De Lima, Nathalia De Carvalho Dias Miranda, Giovanna Zaniolo Margraf, Juliano Riella
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引用次数: 0
Abstract
Introduction: The shortage of organs remains one of the most challenging global problems nowadays. Donor's therapeutic hypothermia was suggested to decrease kidney delayed graft function (DGF) when compared to normothermia in previous trials, but the role of such intervention is still controversial. To assess this, we performed a systematic review and meta-analysis of randomized clinical trials (RCTs) investigating the benefits of donor hypothermia in DGF rate and Graft Failure.
Methods: MEDLINE, Embase, and Cochrane databases were systematically searched for studies of deceased organ donors who underwent hypothermia or normothermia prior to kidney transplantation. Statistical analysis was performed using R Studio version 3.6. Heterogeneity was assessed using I2 statistics and a Baujat Plot.
Results: Four different RCTs were analyzed, including more than 3,000 recipients. Donor hypothermia was associated with a lower, but not statistically significant, rate of DGF (RR 0.87; 95% CI 0.71-1.08; P = .21) and graft failure (RR 0.70; 95% CI 0.45-1.10; P = .12). When analyzing only expanded criteria donors, a significantly lower rate of DGF was observed in the hypothermia-treated group (RR 0.65; 95% CI 0.47-0.89; P = .008). Sensitivity analysis identified one study as an outlier, probably due to protocol deviation. When excluded from the analysis, a significant reduction in DGF rate was observed among the hypothermia-treated group (RR 0.80; 95% CI 0.67-0.94; P = .007).
Conclusion: Our meta-analysis could not find a statistical difference between donor therapeutic hypothermia and normothermia in preventing DGF or Graft Failure. However, these results may be influenced by outliers and the limitations of the included studies. Further research is needed to clarify the role of donor hypothermia in kidney transplantation. If proven beneficial, it could be a promising alternative to sites where preservation techniques are limited, such as low-income countries.
器官短缺仍然是当今最具挑战性的全球性问题之一。在之前的试验中，与常温相比，供体的治疗性低温被认为可以降低肾移植延迟功能（DGF），但这种干预的作用仍然存在争议。为了评估这一点，我们对随机临床试验（rct）进行了系统回顾和荟萃分析，研究了供体低温对DGF率和移植物衰竭的益处。方法：系统地检索MEDLINE、Embase和Cochrane数据库，检索在肾移植前经历过低温或体温正常的已故器官供者的研究。使用R Studio 3.6版本进行统计分析。异质性评估采用i2统计和Baujat图。结果：分析了四种不同的随机对照试验，包括3000多名接受者。供体低温与较低的DGF率相关，但无统计学意义(RR 0.87；95% ci 0.71-1.08；P = 0.21)和移植物衰竭(RR 0.70；95% ci 0.45-1.10；p = .12)。当仅分析扩大标准供者时，观察到低温治疗组DGF率明显较低(RR 0.65；95% ci 0.47-0.89；p = .008)。敏感性分析确定一项研究为异常值，可能是由于协议偏差。当排除在分析之外时，观察到低温治疗组DGF率显著降低(RR 0.80；95% ci 0.67-0.94；p = .007)。结论：我们的荟萃分析没有发现供体治疗性低温和常温在预防DGF或移植物衰竭方面的统计学差异。然而，这些结果可能受到异常值和纳入研究的局限性的影响。需要进一步的研究来阐明供体低温在肾移植中的作用。如果被证明是有益的，它可能是保存技术有限的地方（如低收入国家）的一个有希望的替代方案。系统评价注册：https://www.crd.york.ac.uk/PROSPERO/view/CRD42024581665, PROSPERO （CRD42024581665）。
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