不可控型心脏死亡大鼠供肾移植中的安全热缺血时限

Safe limit of warm ischemic time for rat kidney graft from an uncontrollable cardiac death donor

摘要:

目的：探讨不可控心脏死亡（cardiac death，ＣＤ）后的大鼠供肾耐受热缺血的安全时限。方法：140只SD大鼠随机按热缺血时间长短分成7组，每组20只，供、受者各10只，分别于供鼠心跳停止0、10、20、30、40、50、60 min后进行原位肾移植术，并结扎受鼠的右肾血管，术后观察各组受鼠的生存情况、移植肾功能恢复情况及其纤维化程度。结果：各组冷缺血时间相同（P >0.05），当供肾热缺血时间在30 min以内时，血肌酐均于术后1～2周恢复正常，各组受鼠存活率及移植肾纤维化程度与0 min组比较无显著差异（P >0.05）；当热缺血时间延长至40 min时，受鼠存活率和移植肾纤维化程度与0 min组比较亦均无显著差异（P >0.05），血肌酐于2周后稳定，但明显高于0 min组（P<0.05）；当热缺血时间超过40 min时，受鼠均于1周内死亡。结论：不可控型CD大鼠供肾移植中，供肾热缺血时间应限制在40 min以内，但热缺血时间介于30～40 min的供肾需谨慎使用。

Abstract:

Objective：To investigate the safe limit of warm ischemia time（WIT） for kidney graft after uncontrollable cardiac death（CD） in rat. Methods：Totally 140 SD rats were randomly divided into 7 groups according to the WIT（CD0，CD10，CD20，CD30，CD40，CD50，CD60 groups）. Each group had 20 rats，10 as donors and 10 as recipients. The left kidneys were harvested from the donor rats at 0，10，20，30，40，50，60 min after CD and the harvested left kidneys were transplanted into the left nephrectomized recipient rats whose right renal pedicles were ligated. The survival of recipient rats，recovery of renal function and degree of fibrosis were observed and checked. Results：Cold ischemic time was similar in all groups（P >0.05）. The survival rate，serum creatinine level and allograft fibrosis in CD10，CD20，CD30 groups were all equivalent to those of CD0 group（P >0.05） and the same results were acquired in CD40 group except that the serum creatinine level was higher than that of CD0 group（P<0.01）. All rats implanted with grafts for more than 40 min after CD（CD50 and CD60 groups） died within 7 d. Conclusions：WIT of the donor kidneys should be limited to less than 40 min for rat kidney graft from an uncontrollable CD donor；kidneys with WIT lasting for 30-40 min should be seriously considered for transplant.