Meta analysis of the effect of Lifeport and static cold storage on donor kidney
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摘要:
目的 系统评价Lifeport与静态低温保存(CS)在器官捐献供肾的保存效果。 方法 计算机检索Medline数据库、Embase数据库、考克兰图书馆(Cochrane library)、中国生物医学文献数据库、中国知网、万方数据库和维普数据库,搜集Lifeport与CS在移植肾保存效果的相关临床研究,检索时限均从建库至2015年12月31日。按照纳入与排除标准选择文献,评价质量并提取资料,并评价纳入研究的偏倚风险后,采用Stata 12软件进行Meta分析。 结果 共纳入16个研究,包括5个随机对照试验(RCT)和11个回顾性队列研究(RCS)。Meta分析结果显示:与CS组比较,(1) 总体捐献供肾(TDD),Lifeport组移植术后移植肾功能延迟恢复(DGF)发生率降低,DGF持续时间减少、平均住院日减少以及术后1年肾存活率增加,两组术后急性排斥反应(AR)发生率与1年人存活率相当;(2) 心脏死亡器官捐献供肾(DCD):Lifeport组术后DGF发生率降低,术后平均住院日减少,两组术后移植肾原发性无功能(PNF)与AR发生率,术后1年人、肾存活率比较,差异无统计学意义;(3) 扩展标准供肾(ECD):Lifeport组术后PNF发生率降低并改善术后1年肾存活率,两组术后DGF发生率、AR发生率与术后1年人存活率比较,差异无统计学意义。 结论 Lifeport应用于器官捐献供肾保存具有一定的优势,但受纳入研究数量及质量所限,上述研究结论尚需开展更多高质量研究予以验证。 Abstract:Objective To evaluate the effect of Lifeport and static cold storage (CS) on preservation of donor kidney. Methods Medline, Embase, Cochrane library, CBMdisc, China National Knowledge Infrastructure, Wanfang database and VIP database were searched by computer, and relevant clinical studies on the effect of Lifeport and CS on preservation of transplant kidney were collected, with the search period from database construction to December 31, 2015. According to the inclusion and exclusion criteria, relevant references were selected, quality was evaluated, information was extracted, and risk of bias in the study was evaluated. In addition, Meta analysis was conducted using software Stata 12. Results A total of 16 studies were included with 5 randomized controlled trials (RCT) and 11 retrospective cohort studies (RCS). The results of Meta analysis showed that: compared with Group CS, (1) for total deceased donor (TDD), incidence of delayed graft function (DGF) decreased in Group Lifeport after transplantation, duration of DGF and average length of stay decreased, and 1-year survival rate of kidney increased after operation. The incidence of postoperative acute rejection (AR) and 1-year survival rate of patients were similar in two groups. (2) for donor after cardiac death(DCD): postoperative incidence of DGF and average length of stay decreased in Group Lifeport; there was no statistical significance in incidence of primary nonfunction(PNF) and AR, 1-year survival rate of kidneys and patients between two groups. (3) for expanded criteria donor (ECD): postoperative incidence of PNF decreased and 1-year survival rate of kidney increased in Group Lifeport; there was no statistical significance in postoperative incidence of DGF and AR and 1-year survival rate of kidney between two groups. Conclusion Application of Lifeport in preservation of donor kidney has certain advantages. However, more high-quality studies should be further conducted to verify the study findings due to limited quantity and quality of the study. -
Key words:
- Renal transplantation /
- Lifeport /
- Hypothermic machine perfusion /
- Static cold storage /
- Meta analysis
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表 1 纳入16篇文献的基本情况
Table 1. Characteristics of 16 included studies
研究作者 年份 国家/地区 研究类型 例数 供肾类型 研究指标 Lifeport CS Moustafellos P,et al[7] 2007 英国 RCS 18 18 DCD ①④ Plata-Munoz JJ,et al[8] 2008 英国 RCS 30 30 DCD ①③④⑤⑥⑦ Moers C,et al[9] 2009 欧洲多中心 RCT 336 336 DCD/DBD ①②③④⑤⑥⑦ Jochmans I,et al[10] 2010 欧洲多中心 RCT 82 82 DCD ①②③④⑤⑥⑦ Watson CJ,et al[3] 2010 英国 RCT 45 45 DCD ①③④⑤⑥ Abboud I,et al[11] 2011 法国 RCS 22 22 ECD ①③⑤⑥ Treckmann J,et al[12] 2011 欧洲多中心 RCT 91 91 ECD ①②③⑤⑥⑦ Gallinat A,et al[13] 2012 欧洲多中心 RCT 85 85 ECD ①②③⑤⑥⑦ Sedigh A,et al[14] 2013 瑞典 RCS 36 59 DCD/DBD ①⑦ Dion MS,et al[15] 2014 英国 RCS 15 15 DCD/DBD ① Guy A,et al[16] 2015 英国 RCS 74 101 DCD/DBD ①③ 钟自彪,等[17] 2013 中国 RCS 10 34 DCD ①④ 董建辉,等[18] 2014 中国 RCS 30 30 DCD ①④⑦ 项和立,等[19] 2014 中国 RCS 183 28 DCD ① 王远涛,等[20] 2015 中国 RCS 146 42 DCD ①⑦ 袁小鹏,等[21] 2014 中国 RCS 35 35 DCD ① 注:①DGF发生率;②DGF持续时间;③PNF发生率;④住院时间;⑤术后1年肾存活率;⑥术后1年人存活率;⑦AR发生率 -
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