術中低溫療法對於屍腎移植術後腎功能之影響
王又德1、張兆祥1、黃志平1、陳冠亨1、吳錫金2、蕭博任1、葉進仲1
1中國醫藥大學附設醫院泌尿部
2中國醫藥大學附設醫院北港分院泌尿部
Effect of Intraoperative Hypothermia on Renal Function During Cadaveric Renal Transplantation
Yu-De Wang1, Chao-Hsiang Chang1, Chi-Pen Huang1, Guan-Heng Chen1, Hsi-Chin Wu2, Po-Jen Hsiao1, Chin-Chung Yeh1
1Department of Urology, China Medical University Hospital
2Department of Urology, China Medical University Beigang Hospital
Purpose:
We proposed a simple method of intraoperative hypothermia during cadaveric kidney transplantation. The aim of this study is to evaluate the effect of intra-operative hypothermia on the post-operative renal function.
Materials and Methods:
We performed a retrospective study in patients who underwent cadaveric renal transplantation between April 2012 and October 2018. These patients were divided into 2 groups by the application of intraoperative hypothermia. Demographic information including HLA compatibility and panel-reactive antibody (PRA) were collected. Functional outcomes were accessed by the percentage of acute rejection, delay graft function, slow graft function, post-operative eGFR and serum creatine level and analyzed by ANOVA test. Multivariate logistic regression analysis was used for risk factor evaluation of slow graft function. ROC curve analysis was applied to find the cut off value of hypothermic time in slow graft function.
Results:
There were 19 and 15 patients receiving cadaveric kidney transplantation by hypothermia technique and standard approach respectively. There is no significant difference in demographic information including age, gender, HLA mismatch, PRA level, baseline eGFR, and cold ischemia time. Regarding functional outcome, percentage of slow graft function (26.3 vs 73.3 %, p=0.02), and median 1week-post-OP eGFR (43 vs 14 ml/min/1.73m2, p=0.002) were better in hypothermic group. In multivariate analysis only intraoperative hypothermia independently affected slow graft function (OR:0.02, p=0.02). In ROC curve analysis, we provided the cut off value of 61 minutes in predicting slow graft function (AUC:0.78, p=0.006).
Conclusion:
Adequate hypothermia time within 61 minutes protects patients from slow graft function after cadaveric renal transplantation. Although there were no differences in long-term graft survival.
We recommend intraoperative hypothermia technique as a standard procedure in cadaveric renal transplantation.