2024-03-08 11:49:54来源:中华医学会器官移植学分会阅读:251次
《中国肾脏移植临床诊疗指南》之9
遗体捐献肾脏灌注、保存及修复指南
中华医学会器官移植学分会
图1 供肾灌注、保存及修复示意图
一、指南形成方法
表 1 证据质量与推荐强度分级
二、推荐意见及说明
图2 常温区域灌注示意图
表2 DCD捐献者类型(Maastricht分类)
常温机械灌注(normothermic machine perfusion, NMP)是在接近生理体温的条件下工作,不仅可以减轻冷缺血性损伤,而且能对肾脏质量进行客观评估,并在一定程度上修复缺血性损伤[74]。2011年《移植杂志》首次报道了NMP在肾脏移植中应用,1例热缺血60 min的供肾经NMP后行肾脏移植,术后移植物长期存活[75]。一项随机对照试验纳入39例移植受者,结果显示,NMP组的DGF发生率低于HMP(30.8% vs. 46.2%,P=0.51)。移植术后1年,两组的血清肌酐、肾小球滤过率、尿量、住院时间、并发症发生率、患者生存率和移植物生存率均无显著差异[76]。2023年《自然医学杂志》报道了一项随机对照试验,共纳入290例DCD肾脏,比较SCS和SCS加1小时NMP的效果,两组热缺血时间分别为18 min(14~22)和17 min(13~21)。结果显示,无论是DGF发生率(60.7% vs. 58.5%)、受者生存率(96.3% vs. 97.2%)、移植物存活率(92.2% vs. 95.2%)两组间均无统计学差异[77]。另一项前瞻性研究纳入14例DCD肾脏,结果显示NMP组与SCS组DGF发生率无统计学差异(14% vs. 43%,P=0.56)[78]。以上结果显示NMP是一种安全、可行的临床应用技术,但是,NMP灌注时间较短,对于DCD肾脏保存优势不明显,合适的NMP灌注时间需要更多临床研究明确。目前NMP在临床上使用十分有限,需有更多研究明确其临床应用价值。
三、小结
执笔作者:王彦峰(武汉大学中南医院),林自国(武汉大学中南医院),钟自彪(武汉大学中南医院),范晓礼(武汉大学中南医院),王云昊(武汉大学中南医院)
通信作者:王彦峰(武汉大学中南医院),Email:yanfengwang@whu.edu.cn
主审专家:薛武军(西安交通大学附属第一医院)、武小桐(山西省人体器官获取与分配服务中心)、程颖(中国医科大学附属第一医院)、叶啟发(武汉大学中南医院)、霍枫(广州军区广州总医院)
审稿专家(按姓氏笔画排序):丁小明(西安交通大学附属第一医院)、丁晨光(西安交通大学附属第一医院)、门同义(内蒙古医科大学附属医院)、王长希(中山大学附属第一医院)、田野(首都医科大学附属北京友谊医院)、田普训(西安交通大学第一附属医院)、付迎欣(深圳市第三人民医院)、戎瑞明(复旦大学附属中山医院)、朱有华(海军军医大学附属长海医院)、刘龙山(中山大学附属第一医院)、孙启全(广东省人民医院)、孙煦勇(广西医科大学附属第二医院)、寿张飞(树兰(杭州)医院)、吴建永(浙江大学医学院附属第一医院)、张伟杰(华中科技大学同济医学院附属同济医院)、张明(上海交通大学医学院附属仁济医院)、陈刚(华中科技大学同济医学院附属同济医院)、林涛(四川大学华西医院)、尚文俊(郑州大学第一附属医院)、周华(山西省第二人民医院)、周江桥(武汉大学人民医院)、赵闻雨(海军军医大学附属长海医院)、胡小鹏(首都医科大学附属北京朝阳医院)、宫念樵(华中科技大学同济医学院附属同济医院)、蔡明(浙江大学医学院附属第二医院)
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