Combined Ex Vivo Hypothermic and Normothermic Perfusion for Assessment of High-risk Deceased Donor Human Kidneys for Transplantation
| Autor: | Sandra K Kabagambe, Tristan Boyer, Yulia Smolin, Ivonne Palma, Chandrasekar Santhanakrishnan, Ivania Palma, John P. McVicar, Junichiro Sageshima, Richard V Perez, Christoph Troppmann, Kuang-Yu Jen, Miriam A Nuno |
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| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Urology Delayed Graft Function Hemodynamics Hypothermia Medical and Health Sciences Cold Ischemia Time Hypothermia Induced Medicine Humans Aged Deceased donor Transplantation Machine perfusion Kidney business.industry Induced Cold Ischemia Middle Aged Original Clinical Science—General Kidney Transplantation Tissue Donors Perfusion Normothermic perfusion medicine.anatomical_structure Anesthesia Renal blood flow Surgery Female business Packed red blood cells Ex vivo |
| Zdroj: | Transplantation Transplantation, vol 103, iss 2 |
| ISSN: | 1534-6080 0041-1337 |
| Popis: | Background Despite careful clinical examination, procurement biopsy and assessment on hypothermic machine perfusion, a significant number of potentially useable deceased donor kidneys will be discarded because they are deemed unsuitable for transplantation. Ex vivo normothermic perfusion (EVNP) may be useful as a means to further assess high-risk kidneys to determine suitability for transplantation. Methods From June 2014 to October 2015, 7 kidneys (mean donor age, 54.3 years and Kidney Donor Profile Index, 79%) that were initially procured with the intention to transplant were discarded based on a combination of clinical findings, suboptimal biopsies, long cold ischemia time (CIT) and/or poor hypothermic perfusion parameters. They were subsequently placed on EVNP using oxygenated packed red blood cells and supplemental nutrition for a period of 3 hours. Continuous hemodynamic and functional parameters were assessed. Results After a mean CIT of 43.7 hours, all 7 kidneys appeared viable on EVNP with progressively increasing renal blood flow over the 3-hour period of perfusion. Five of the 7 kidneys had excellent macroscopic appearance, rapid increase in blood flow to 200 to 250 mL/min, urine output of 40 to 260 mL/h and increasing creatinine clearance. Conclusions Favorable perfusion characteristics and immediate function after a 3-hour course of EVNP suggests that high-risk kidneys subjected to long CIT may have been considered for transplantation. The combined use of ex vivo hypothermic and normothermic perfusion may be a useful strategy to more adequately assess and preserve high-risk kidneys deemed unsuitable for transplantation. A clinical trial will be necessary to validate the usefulness of this approach. The combined use of ex vivo hypothermic and normothermic perfusion may be a useful strategy to more adequately assess and preserve high-risk kidneys deemed unsuitable for transplantation. |
| Databáze: | OpenAIRE |
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