Early results of a non-heartbeating donor (NHBD) programme with machine perfusion

Abstract

Freeman Hospital, Newcastle upon Tyne restarted their non-heartbeating donor (NHBD) programme in September 1998 using machine perfusion, due to early poor results with conventional cold storage (45% graft survival, phase II). Since then, 15 NHBD kidneys have been transplanted. The retrieval protocol consisted of in situ perfusion with a double balloon triple lumen cannula in Maastricht category II male donors age range 13-59 years. Mean primary warm ischaemic time was 24.8 min (range 10-44). All kidneys were machine perfused through a locally developed perfusion system. The viability was assessed by serial measurements of total GST (maximum acceptable limit of 200 units/l) and intrarenal vascular resistance (IRVR) was recorded. Fifteen of the 22 kidneys (68.62%) were transplanted. Delayed graft function (DGF) was seen in ten recipients (66.6%), two kidneys had immediate function (IF), one organ was exported, two recipients died of unrelated causes and a further seven kidneys were discarded (two had high tGST, two were infected and three had poor flow characteristics). In phase III, a success rate of 91.7% was thus achieved, which was better than the phase II period (P = 0.027, Fisher 2-tail test). Machine perfusion has been successfully introduced in phase III to the Newcastle NHBD programme and facilitates viability assessment of NHBD kidneys.

The clinical and cost-effectiveness of pulsatile machine perfusion versus cold storage of kidneys for transplantation retrieved from heart-beating and non-heart-beating donors

“…Of these, nine [52][53][54][55][56][57][58][59][60] were published between 1974 and 1981, reporting seven studies of the use of perfusate flow characteristics and biochemical markers. A further 17 papers published since 1993 have been identified, [61][62][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77] reporting 11 studies. Details of all studies are given in Table 4.…”

“…A further 17 papers have been identified, [61][62][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77] reporting 11 studies, all but one 77 of which were in NHBD or 'extended donor' kidneys. In only one of these 67,68 studies were kidneys not rejected from transplantation due to perfusion characteristics (thus making it impossible to assess how they would have performed if transplanted).…”

“…In three studies, 61,[64][65][66]72,73 the fact that the majority of kidneys, preselected for transplantation using perfusion criteria, functioned postoperatively is put forward as vindication of those criteria. Clearly, without a proper control group, this conclusion is not justified.…”

Kidney transplantation from non-heart-beating donors after oxygenated low-flow machine per fusion preservation with histidine-tryptophan-ketoglutarate solution

“…While the number of patients on the waiting list for kidney transplantation rises steadily, the rate of available donor organs remains rather static. The recent upsurge in retrieval from donors after the heart has stopped beating helps to enlarge the donor pool but might create difficulties concerning organ viability after warm ischaemic insult [8]. The quality of organ preservation during ischaemic storage may have a significant effect on renal allograft outcome after transplantation and may modulate the risk of long-term complications.…”

Current status and recent advances of liver transplantation from donation after cardiac death

“…Understanding the pathophysiology of DCD donation has enabled many investigators to explore the impact of pharmacological manipulation and both in-situ and ex-situ machine perfusion has begun to become a real clinical possibility. The success of ex-situ machine perfusion of kidney grafts from DCD donors [12,[47][48][49] has been begun to be adapted by other specialties, including cardiac transplantation [50] . Numerous methods of improving the quality of the DCD grafts have been described and the different terminology adds to confusion.…”