Delayed graft function and perfusion parameters of kidneys from uncontrolled donors after circulatory death

Abstract

<jats:p> Better preservation and evaluation of kidneys from donors after circulatory death serve to increase the number of kidneys available for transplantation and hypothermic machine perfusion has been shown to decrease ischemia reperfusion injury and delayed graft function. Data on relation between hemodynamic parameters during hypothermic machine perfusion and delayed graft function in kidneys from donors after circulatory death are so far scarce and not univocal. We aimed at assessing whether hemodynamic parameters measured during hypothermic machine perfusion (flow, mean perfusion pressure, and renal resistance) are associated with delayed graft function in 26 kidneys retrieved from uncontrolled donors after circulatory death. In our series, the incidence of delayed graft function was 57.7% (15/26). Recipients who developed delayed graft function had a longer warm ischemic time (p = 0.04). All hemodynamic parameters measured during hypothermic machine perfusion were comparable between recipients with delayed graft function and those without. According to our data, in kidneys from uncontrolled donors after circulatory death, a longer warm ischemic time (that is the overall time of no flow, as the sum of the no-flow and the no-touch period) is associated with delayed graft function. This finding underscores the pivotal role of ischemic injury in terms of absence of flow in affecting graft function. No association was detectable between hemodynamic parameters during hypothermic machine perfusion and the development of delayed graft function in our series. </jats:p>

Novel Ex-Vivo Thrombolytic Reconditioning of Kidneys Retrieved 4 to 5 Hours After Circulatory Death

“…Despite these measures, kidney recipients of uDCD donors typically present with acute tubular necrosis (ATN), observed as delayed graft function (DGF). [6][7][8][9][10][11][12][13][14] Acute rejection with differential diagnostic difficulties, vascular thrombosis, and prolonged hospitalization are routinely observed in these recipients. 8,12,15 Families of the deceased need time to provide donor consent after confirmation of a close relative's death.…”

A Review of Current and Emerging Trends in Donor Graft-Quality Assessment Techniques

“…Their findings showed that resistances at two hours and beyond predicted DGF, while initial resistance to machine perfusion predicted one-year graft survival post-transplantation [35]. On the other hand, some studies found no association between hemodynamic parameters during HMP and the development of DGF [27]. Thus, due to these inconclusive results, the perfusion parameters cannot be regarded as stand-alone criteria.…”

“…Static cold storage (SCS) and HMP are the main techniques of kidney graft preservation [26]. HMP has become a frequently and widely used procedure in kidney transplantation over the past few years [26][27][28]. Indeed, several reports have shown that the HMP reconditioning effect results in better postoperative outcomes with respect to reducing DGF and better long-term graft survival after transplantation [29][30][31].…”

“…An important benefit of HMP is that it enables the monitoring of perfusion parameters that could predict post-transplant organ viability. In particular, flow rate and renal resistance (RR) have been among the most frequently used perfusion parameters in predicting post-transplant function [27,[32][33][34]. Previous studies have produced findings suggesting that real-time RR detection provides good predictive value.…”

Advances in Hypothermic and Normothermic Perfusion in Kidney Transplantation

“…In general, warm ischaemia arises prior to donation [13] and results in impaired delivery of oxygen and metabolic substrates [14,15]. This drives an anaerobic shift [14] and crucially ATP depletion [16], which results in widespread deterioration of tissue structure [17][18][19][20][21][22]. The warm ischemic injury incurred also stimulates damaging inflammatory responses [23].…”