Assessment of Non-Heart-Beating Donor (NHBD) Kidneys for Viability on Machine Perfusion

Balupuri, S.; Buckley, P.; Mohamed, Mostafa; Cornell, Christopher; Mantle, David; Kirby, John A.; Manas, Derek; Talbot, David

doi:10.1515/cclm.2000.164

Cited by 34 publications

(25 citation statements)

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“…There have been numerous controlled trials and observational studies examining storage techniques with regard to the impact of preservation methods on delayed graft function (DGF), acute rejection, renal function and graft survival (4)(5)(6)(7)(8)(9)(10)(11). Studies have examined outcomes in lieu of changes in immunosuppressive developments (12), the appropriate selection of organs applicable for PP (13)(14)(15)(16), the cost-effectiveness of storage techniques (17) and the impact of particular perfusates (18)(19)(20). In general, PP of kidneys is considered to function through stabilization of the organ by supplying nutrients and oxygen during storage, by decreasing intrarenal vasospasm and by removal of waste materials while mimicking circulation and increasing vascular compliance.…”

Section: Introductionmentioning

confidence: 99%

Are We Frozen in Time? Analysis of the Utilization and Efficacy of Pulsatile Perfusion in Renal Transplantation

Schold

Kaplan

Howard

et al. 2005

American Journal of Transplantation

146

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Preservation techniques are crucial to deceased donor kidney transplantation (DDTx), but the efficacy of pulsatile perfusion (PP) versus cold storage (CS) remains uncertain. We describe patterns of PP use and explore four fundamental questions. What kidneys are selected for PP? How does PP affect utilization of donated kidneys? What effect does PP have on outcomes? When does PP appear to be most efficacious? We examined rates of PP in DDTx in the United States from 1994 to 2003. We generated models for organ utilization, delayed graft function (DGF) and for the use of PP. We analyzed the long-term effect of PP with multivariate Cox models. The utilization rates for nonexpanded criteria donors (ECDs) were similar by storage type, but for ECDs there was a significantly higher utilization rate with PP (70% with PP vs. 59% with CS, p < 0.001). Use of PP was widely variable across transplant centers. DGF rates were significantly lower with PP (27.6% vs. 19.6%). PP was associated with a mild benefit on death censored graft survival (adjusted hazard ratio = 0.88, 95% CI 0.85-0.91). Reduced DGF and significantly lower discard rates of ECDs associated with PP suggest an important utility of PP in renal transplantation. Additional evidence of improvement in graft survival, particularly in more recent years, provides further encouraging evidence for the use of PP.

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Section: Introductionmentioning

confidence: 99%

Are We Frozen in Time? Analysis of the Utilization and Efficacy of Pulsatile Perfusion in Renal Transplantation

Schold

Kaplan

Howard

et al. 2005

American Journal of Transplantation

146

View full text Add to dashboard Cite

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“…Pre-transplant assessment of NHB donor kidneys in order to select viable grafts for transplantation is of crucial importance (5)(6)(7). Perfusion characteristics of kidneys preserved by machine pulsatile perfusion are used to evaluate organ viability (8,9).…”

Section: Introductionmentioning

confidence: 99%

Redox-Active Iron Released During Machine Perfusion Predicts Viability of Ischemically Injured Deceased Donor Kidneys

Vries

Snoeijs

Bonsdorff

et al. 2006

American Journal of Transplantation

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Redox-active iron, catalyzing the generation of reactive oxygen species, has been implicated in experimental renal ischemia-reperfusion injury. However, in clinical transplantation, it is unknown whether redoxactive iron is involved in the pathophysiology of ischemic injury of non-heart-beating (NHB) donor kidneys. We measured redox-active iron concentrations in perfusate samples of 231 deceased donor kidneys that were preserved by machine pulsatile perfusion at our institution between May 1998 and November 2002 using the bleomycin detectable iron assay. During machine pulsatile perfusion, redox-active iron was released into the preservation solution. Ischemically injured NHB donor kidneys had significantly higher perfusate redox-active iron concentrations than heartbeating (HB) donor kidneys that were not subjected to warm ischemia (3.9 ± 1.1 vs. 2.8 ± 1.0 lmol/L, p = 0.001). Moreover, redox-active iron concentration was an independent predictor of post-transplant graft viability (odds ratio 1.68, p = 0.01) and added predictive value to currently available donor and graft characteristics. This was particularly evident in uncontrolled NHB donor kidneys for which there is the greatest uncertainty about transplant outcomes. Therefore, perfusate redox-active iron concentration shows promise as a novel viability marker of NHB donor kidneys.

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“…Durante años el único criterio válido para demostrar la viabilidad de un riñón que ha sido trasplantado era el propio trasplante. Son numerosos los trabajos que hablan sobre la posibilidad que ofrece la perfusión pulsátil para asesorar acerca de la viabilidad del trasplante y proporcionar información de la RVR, el FVR y otros parámetros hemodinámicos [46][47][48] .…”

Section: Discussionunclassified

Caracterización histológica y hemodinámica del injerto con isquemia caliente según el método de preservación

et al. 2008

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órganos de donantes a corazón parado abre una vía para solucionar la escasez de órganos para trasplante. Por la naturaleza de estos donantes los riñones sufren un periodo variable de isquemia normotérmica (IN) antes de su extracción, que puede dañar el injerto y condicionar su supervivencia. Minimizar el daño producido al riñón durante la extracción, los diferentes tipos de conservación hipotérmica y su posterior trasplante resulta clave para mejorar los resultados obtenidos con este tipo de injertos.Pretendemos evaluar mediante un modelo experimental, que somete al injerto renal a un periodo de IN, las consecuencias estructurales y hemodinámicas de la perfusión hipotérmica (PH) frente a la hipotermia simple (HS). Todo el procedimiento fue monitorizado y registrado mediante un sistema informatizado. La resistencia vascular renal (RVR) y el flujo vascular renal (FVR) fueron registrados en tiempo real tras el desclampaje. Llevamos a cabo estudio histológico mediante microscopía convencional y electrónica.Resultados: Observamos 2 patrones evolutivos post-trasplante: 1. Incremento inicial de RVR con descenso posterior e incremento del flujo vascular: órganos con IN y PH previa al trasplante (grupo B) // órganos sin isquemia previa y trasplante (grupo C-control). Microscopía convencional-electrónica: integridad túbulo-endotelial.2. Descenso inicial de RVR con incremento posterior: órganos con IN y trasplante directo (A)//órganos con isquemia previa e HS de 60 min. (D). Alteraciones túbulo-endoteliales en micro convencional-electrónica.Conclusiones: La PH en bomba preserva mejor, a nivel experimental, la ultraestructura túbulo-endotelial de los riñones sometidos a IN prolongada. La hemodinámica post-trasplante de los órganos sometidos isquemia y PH sigue un patrón similar a la de los órganos sin IN previa y trasplantados directamente.Palabras clave: Isquemia normotérmica. Preservación de órganos. ABSTRACT HYSTOLOGIC AND HEMODYNAMIC ASPECTS OF WARM ISCHEMIC GRAFT IN RELATION TO THE PRESERVATION METHODObjective: The non-heart-beating donor has been proposed as a solution to donor shortage for renal transplantation. Because the nature of such donors, the kidneys so derived have been damaged by primary warm ischemia (WI), and so potentially they may never function. Minimizing graft injury is especially important in case of transplantation form marginal donors because of a high rate of delayed graft function or primary nonfunction. The aim of this experimental study is to assess the structural and hemodynamic consequences of hypothermic perfusion (HP) versus cold storage (CS), in renal allograft after a period of WI.Material and Methods: We used 20 mini-pigs. WI was achieved by vascular pedicle occlusion during 45 min. We divided organs in 4 groups: A (n=5), kidneys with WI and then transplanted; group B (n=5), grafts with WI and implanted after HP with Belzer solution in our computerized perfusion system. Group C-control, (n=5) transplanted without WI and D (n=5) with WI and 60 min of CS in UW-Viaspan solution.All the pro...

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Assessment of Non-Heart-Beating Donor (NHBD) Kidneys for Viability on Machine Perfusion

Cited by 34 publications

References 10 publications

Are We Frozen in Time? Analysis of the Utilization and Efficacy of Pulsatile Perfusion in Renal Transplantation

Are We Frozen in Time? Analysis of the Utilization and Efficacy of Pulsatile Perfusion in Renal Transplantation

Redox-Active Iron Released During Machine Perfusion Predicts Viability of Ischemically Injured Deceased Donor Kidneys

Caracterización histológica y hemodinámica del injerto con isquemia caliente según el método de preservación

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