CAJ | 학술논문

背景：目前，国内外低温机械灌注与冷保存对肾移植预后影响的文章比较多，但结论各异，且由于大多单个研究样本量存在局限，对低温机械灌注的优缺点缺乏客观评价。目的：比较低温机械灌注与冷保存对肾移植预后的影响。方法：计算机检索PubMed、sinoMed、EMbase、Web of Science、the Cochrane Central Register of Controled Trials (CENTRAL)、万方数据库及中国知网，查找并筛选出所有比较低温机械灌注与冷保存对肾移植预后影响的随机对照试验(Randomized Controled Trial，RCT)，同时手检纳入文献的参考文献，检索时限均为建库至2015年3月4日。按纳入排除标准由2位评价者独立进行RCT的筛选、资料提取和质量评价后，采用RevMan(5.3.0版)软件进行Meta分析，并采用GRADEpro3.6软件进行证据质量评价。结果与结论：共纳入文献6篇，低温机械灌注保存供肾共619例，冷保存保存供肾共620例。结果显示：低温机械灌注组原发性移植物无功能发生率、功能性移植肾功能延迟恢复发生率、移植肾功能延迟恢复发生率均显著低于冷保存组(P <0.05或0.01)。患者1年生存率、移植物1年存活率差异均无显著性意义(P >0.05)。结果表明低温机械灌注保存供体只能降低肾移植后近期并发症的发生率，维护肾脏功能，但无法提高患者1年生存率和移植物1年存活率，相比较冷保存的保存方式，低温机械灌注对供体器官的保护无长期优势。
배경：목전，국내외저온궤계관주여랭보존대신이식예후영향적문장비교다，단결론각이，차유우대다단개연구양본량존재국한，대저온궤계관주적우결점결핍객관평개。목적：비교저온궤계관주여랭보존대신이식예후적영향。방법：계산궤검색PubMed、sinoMed、EMbase、Web of Science、the Cochrane Central Register of Controled Trials (CENTRAL)、만방수거고급중국지망，사조병사선출소유비교저온궤계관주여랭보존대신이식예후영향적수궤대조시험(Randomized Controled Trial，RCT)，동시수검납입문헌적삼고문헌，검색시한균위건고지2015년3월4일。안납입배제표준유2위평개자독립진행RCT적사선、자료제취화질량평개후，채용RevMan(5.3.0판)연건진행Meta분석，병채용GRADEpro3.6연건진행증거질량평개。결과여결론：공납입문헌6편，저온궤계관주보존공신공619례，랭보존보존공신공620례。결과현시：저온궤계관주조원발성이식물무공능발생솔、공능성이식신공능연지회복발생솔、이식신공능연지회복발생솔균현저저우랭보존조(P <0.05혹0.01)。환자1년생존솔、이식물1년존활솔차이균무현저성의의(P >0.05)。결과표명저온궤계관주보존공체지능강저신이식후근기병발증적발생솔，유호신장공능，단무법제고환자1년생존솔화이식물1년존활솔，상비교랭보존적보존방식，저온궤계관주대공체기관적보호무장기우세。
BACKGROUND:At present, there are a number of articles about hypothermic machine perfusion versus static cold storage of kidney alografts; however, the conclusions are various. Furthermore, due to the limitation of single sample size, there is a lack of objective evaluation on the merits and demerits of hypothermic machine perfusion. OBJECTIVE: To compare the prognostic outcomes of hypothermic machine perfusion and static cold storage of kidney alografts. METHODS: A computer-based search of PubMed, sinoMed, EMbase, Web of Science, the Cochrane Central Register of Controled Trials (CENTRAL), Wanfang and CNKI databases were searched from their establishment to March 4, 2015 to screen the randomized controled trials (RCTs) about hypothermic machine perfusion versus static cold storage for kidney transplantation. Meanwhile, the references of included RCTs were also searched by hand. After study selection, RCTs screening, data extraction and quality assessment were conducted by two reviewers independently. Meta-analyses were performed by using the RevMan5.3.0 software. The quality of evidence was assessed by using the GRADEpro3.6 software. RESULTS AND CONCLUSION: Six articles were included, involving 619 cases undergoing hypothermic machine perfusion and 620 cases undergoing static cold storage. The results of Meta-analyses showed that the incidence of primary graft non-function, incidence of delayed graft function of functional kidney alografts, and incidence of delayed graft function were significantly lower in the hypothermic machine perfusion group than the static cold storage group (P < 0.05 or 0.01). There were no differences in the 1-year recipient survival rate and 1-year alograft survival rate between the two groups (P > 0.05). These findings indicate that the hypothermic machine perfusion only can reduce the incidence of postoperative complications to maintain the function of kidney, but cannot improve the 1-year recipient survival rate and 1-year alograft survival rate. Hypothermic machine perfusion has no advantage on the long-term preservation of donor organ compared with the static cold storage.