腎臓移植の研究 9. Perfluorochemical emulsionを用いた腎低温灌流保存の実験的研究

Abstract

長時間の腎保存と保存中の腎のviability判定の示標を検討するため, cryoprecipitated plasmaをbaseに酸素運搬体であるperfluorochemical emulsionを添加したものを灌流液とし用い, 犬腎の低温灌流保存実験をした.1) 48時間保存では, FC (+)群, FC (-)群ともにそれぞれ1例ずつ生着犬を得た.灌流状態と保存中の腎重量増加には, FC添加による差はみなかったが, FC (+)群の方が灌流液中のLDH活性はより低く, 生着例の腎機能も良好で, 移植腎の組織学的変化も軽微であった.2) 72時間保存では, FC (+)群6例中3例が生着し, FC (-)群は1例中1例が生着した.灌流状態と腎重量増加はFC添加による差はなかった.組織学的にはFC (+)群の方が尿細管の変化が軽かった.3)保存中の腎のviabilityの判定には, 単位時間, 単位重量当たりの腎灌流量の経時的観察がもっとも有用で, 灌流圧を高くすることなく, 灌流量を最後まで保つことが, 腎の良好な低温灌流保存の必要条件と考えた

The unilateral kidney of mongrel dog was removed and flushed out with modified Collins C3 solution, and then preserved by pulsatile perfusion machine (MOX-100) at low temperature of 4-6 degrees C. During the perfusion, systolic pressure was controlled below 60 mmHg. After a 48-hr or 72-hr preservation, the kidney was autotransplanted to the iliac fossa of the same dog. The perfusate consisted of cryoprecipitated plasma (CPP) of the dogs supplemented with or without 5 W/V% perfluorochemical emulsion (FC-43). At an early stage, our CPP formed fibrin mass easily, thus being very unstable. But silicagel treatment of the CPP improved stability. Twenty six kidneys were perfused for preservation, but perfusion of 7 kidneys was stopped by decreased perfusion flow and increased perfusion pressure. Eight kidneys were lost due to technical failure of transplantation or infection after autotransplantation; 11 kidneys were used as planned. The 48-hr preservation group contained 2 cases of FC (+) and 2 cases of FC (-). Each group had one survival case. The 72-hr preservation group contained 6 cases of FC (+), and one case of FC (-). Three cases survived in the FC (+) group and one case survived in the FC (-) group. Survival cases maintained enough perfusion flow which was above 0.3 ml/min. g. kidney. Weight gains of the preserved kidneys during 72-hr preservation were 13 +/- 19% in FC (+) and 21 +/- 17% in FC (-) group, but had no relation to preservation condition.(ABSTRACT TRUNCATED AT 250 WORDS)