| ?Objective?The maintenance and protection of transplanted organ is a new problem in clinical practice,after full access to the CDCD organ source.In this study,the protective effect of urokinase on the function of CDCD donor kidney was investigated by comparison and analysis of two parts of the randomized controlled paired double-blind and the expanded clinical study.?Methods?We selected 55 CDCD donors,which met the inclusion criteria and exclusion criteria,and 82 kidneys were allocated by Organ allocation system of China as the donor kidneys,which were completed by The Second Hospital University of South China during August,2015 to January,2018.82 kidneys were taken by perfusion interventions,of which 50 kidneys were perfused with urokinase?test group?and 32 kidneys perfusions did not use urokinase?control group?.Of the 82 kidneys,24 pairs of 48 kidneys were the randomized controlled paired double-blind trial to the urokinase perfusion group?test group?and the non-Urokinase group?control group?.And complete clinical data of preoperative and postoperative were obtained.34 kidneys were not enter the randomized controlled trial,26 were given with urokinase perfusion?test group?,and 8 were not given with urokinase perfusion?control group?.The clinical data of preoperative and postoperative were complete.The randomized paired controlled double-blind trial was the first part of the study,and another 34 kidneys did not enter the randomized controlled trial because of organ allocation and the donor reasons.Statistical analysis of the data was divided into two parts.The first part,the randomized controlled double-blind trial study,the test group:the control group was 24:24.The second part,according to whether or not receiving urokinase perfusion,82 transplanted kidneys were divided into the test group and the control group.The number of cases in the two group was 50:32.After allograft kidney transplantation,methylprednisolone,tacrolimus and mycophenolate mofetil were routinely used for anti-rejection therapy.Follow up and analysis of some of the clinical indicators such as the rate of DGF,urine volume at each time within 24 hours,serum creatinine?SCr?,SCr reduction ratio and Cystatin C?Cys C?at each time period within 1 month after kidney transplantation.?Results?1.In the randomized controlled paired double-blind trial study:test group?n=24?and control group?n=24?To compare the urine volume at each time period within 24 h and and total 24 h urine volume:the urine volume in the test group was more than the control group in 24 h.There was a statistical difference in the urine volume between the 2nd,4th,6thhour and the 8thhour after kidney transplantation?P<0.05?.There was no statistical difference within 10-24 h after kidney transplantation?P>0.05?.The total urine volume of 24 h in the test group was 6423±3720.1ml after operation,and the total urine volume of 24 h in the control group was 5391.8±5465.3ml after operation.There was no significant difference between the two groups?t=1.045,P=0.307>0.05?.To compare the SCr within 1 month:the SCr in the test group was lower than the control group within 1 month after kidney transplantation,and there was a statistical difference in the SCr within 28 days after kidney transplantation?t=-2.309,P=0.03<0.05?.To compare the SCr reduction ratio within 1 month:the SCr reduction ratio in the test group was more than the control group within 1month after kidney transplantation,and there was a statistical difference in the SCr reduction ratio within 28 days after kidney transplantation?t=2.243,P=0.035<0.05?.To compare the Cys C within 1 month:the Cys C in the test group was lower than the control group within 1 month after kidney transplantation,and there was a statistical difference in the Cys C within28 days after kidney transplantation?t=-2.159,P=0.042<0.05?.The rate of DGF:The rate of DGF after kidney transplantation in the test group was 12.50%,and 41.67%in the control group.The difference between the two groups was statistically significant??2=5.169,P=0.023<0.05?.2.In the expanded clinical trial study:test group?n=50?and control group?n=32?To compare the urine volume at each time period within 24 h and and total 24 h urine volume:the urine volume in the test group was more than the common group in 24 h,and there was a statistical difference in the urine volume between the 2nd,4th,6thhour and the 8thhour after kidney transplantation?P<0.05?.There was no statistical difference within the 10-24 h after kidney transplantation?P>0.05?.The total urine volume of 24 h in the test group was 6379.0±4046.6ml after operation,and the total urine volume of 24 h in the control group was5141.4±5273.7ml after operation.There was no significant difference between the two groups?t=1.198,P=0.234>0.05?.To compare the SCr within 1 month:the SCr in the test group was lower than the control group within 1 month after kidney transplantation,and there was a statistical difference in the SCr between the 1st,3rd,5thday and the 7thday after kidney transplantation?P<0.05?.There was no statistical difference in the 14th,21thday and the 28thday after kidney transplantation?P>0.05?.To compare the SCr reduction ratio within 1 month:the SCr reduction ratio in the test group was more than the control group within 1month after kidney transplantation,and there was a statistical difference in the SCr reduction ratio between the 1st,3rd,5thday and the 7thday after kidney transplantation?P<0.05?.There was no statistical difference in the 14th,21thday and the 28thday after kidney transplantation?P>0.05?.To compare the Cys C within 1 month:the Cys C in the test group was lower than the control group within 1 month after kidney transplantation,and there was a statistical difference in the Cys C between the 1st,3rd,5thh and the 7thh day after kidney transplantation?P<0.05?.There was no statistical difference in the 14th,21thday and the 28thday after kidney transplantation?P>0.05?.The rate of DGF:The rate of DGF after kidney transplantation in the test group was 18.00%,and 40.63%in the control group.The difference between the two groups was statistically significant??2=5.088,P=0.024<0.05?.?Conclusion?1.In the randomized paired controlled double-blind trial study,the preservation effect of continuous hypothermic perfusion of urokinase into the organ preservation on CDCD kidney was better than the ordinary continuous hypothermic perfusion on some ways of the urine output within 8 hours,the creatinine value,the decrease rate of the serum creatinine and the serum cystatin C value within 28 days after the operation and the reduction of the DGF occurrence.2.In the expanded clinical trial study,the preservation effect of continuous hypothermic perfusion of urokinase into the organ preservation on CDCD kidney was better than the ordinary continuous hypothermic perfusion on some ways of the urine output within 8 hours,the creatinine value,the decrease rate of the serum creatinine and the serum cystatin C value within 7 days after the operation and the reduction of the DGF occurrence.3.The effect of urokinase into the organ preservation solution by continuous hypothermic perfusion and preservation of CDCD donor kidney was better than that of the ordinary continuous hypothermic perfusion on improving early kidney allograft function recovery. |
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