| ?Objective? Under different perfusion mode,the rate of early renal allograft(BFAR)and interlobar arterial resistance index(RI),together with Interlobar artery pulsatility index(PI),mean interlobar artery velocity(Vmean),end-diastolic velocity(EDV)and other hemodynamic parameters,after renal transplantation were compared between donation after citizens' death,to explore the relationship between urokinase and Life Port in improving blood flow after renal transplantation for ischemic DCD Kinetic aspects of synergy;and by comparing urokinase with Life Port group(experimental group)and Life Port group(control group)recipients at different time points within 1 month after 24-hour urine output,serum creatinine and DGF Rate,analyze the relationship between the early hemodynamics and renal function recovery of the recipients between the two groups.?Methods? A total of 27 donors who met the inclusion criteria were selected from the DCD completed from September 2016 to January 2018 at the Second Affiliated Hospital of University of south China.According to the principle of randomization,each donor's two kidneys were divided into two groups.The experimental group used urokinase combined with Life Port perfusion and the control group used only simple mechanical perfusion with Life Port.The pre-perfusion pressure of thses two groups was 35 mm Hg,total perfusion time was 5h.Perfused kidneys were further trimmed and washed with the same hypertonic citric acid adenine solution(HCA)at the same pressure to remove residual urokinase.The same principle of randomization,the treatment of the kidneys were carried out allogeneic kidney transplant,postoperative to mycophenolate mofetil dispersible tablets + tacrolimus capsules + methylprednisolone triple anti-rejection therapy,the rest respectively anti-infective,protect liver and stomach function,control of blood pressure and other symptomatic treatment.Within one month after operation,the color Doppler ultrasound was used to observe the BFAR,RI,PI,Mean velocity(Vmean)and end-diastolic velocity(EDV),were used to evaluate the early hemodynamics of the two groups.The 24-hour urine output and serum creatinine were measured at different time points within one month after operation.The incidence of DGF in the experimental and control groups were calculated respectively to evaluate the early renal function recovery of the two groups.?Results? The comparison of hemodynamics of transplanted kidney between two groups within 1 month after operation: The mean of BFAR in experimental group was higher than that of control group on the 1st,7th,14 th and 28 th day after operation (P<0.05).On the 1st day and the 14 th day after operation,the average RI of mean intercortical renal artery transplants in the experimental group was lower than that in the control group,the average value of inter-articular RI was significantly different between the two groups(P<0.05).On the 14 th day and the 28 th day after operation,the mean value of Arterial RI,there was no significant difference between the two groups(P>0.05);on the 1st day and the 14 th day after the operation,the mean PI of transplanted renal artery in the experimental group was lower than that in the control group,the difference between the two groups was statistically significant(P<0.05),on the 14 th day and the 28 th day after the operation,PI in the control group transplanted into the interrenicle artery was close to that in the control group PI mean was similar,the difference between the two groups was not statistically significant(P>0.05).on the 1st and 14 th day,Compared with the control group,the mean Vmean of interrenal arteries in the experimental group was significantly higher than that in the control group(P<0.05).On the 14 th day after the operation,The Vmean mean value of interrenal arteries transplanted in the control group was close to the mean Vmean mean of interrenal graft arteries in the control group on the 28 th day.There was no significant difference between the two groups(P>0.05)Compared with the control group,the average value of EDV in transplanted renal arteries in the experimental group was significantly higher than that in the control group(P<0.05).On the 14 th day and the 14 th day after the operation,Compared with the same period of 28 days,the mean value of EDV in the control group transplanted into the interrenal artery was close to that in the test group.There was no significant difference between the two groups(P>0.05).Within 1 month after operation,the renal function indexes of the two groups were compared: the average 24-hour urinary output of the experimental group was higher than that of the control group within 24 hours of the same period in 1 month after operation,and the difference between the two groups was significant(P<0.05).Mean serum creatinine in the experimental group was lower than that of the control group in the same period(P<0.05).The difference between the two groups was statistically significant(P<0.05).The incidence of DGF in the experimental group was significantly less than that in the control group,with significant difference between the two groups(P<0.05).?Conclusion? Urokinase combined with Life Port perfusion has more obvious advantages than pure Life Port mechanical perfusion in improving the early hemodynamics after ischemic DCD donor kidney transplantation;within 1 month after renal transplantation,hemodynamic better urine Kinase combined with Life Port perfusion group recipients compared with Life Port group recipients,the former renal function recovery is better. |
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