Effect of machine perfusion preservation on delayed graft function in non-heart-beating donor kidneys -early results

Daemen, J. H. C.; Vries, Bart de; Oomen, A.P.A.; Kootstra, G.; Demeester, Joseph

doi:10.1111/j.1432-2277.1997.tb00710.x

Cited by 11 publications

(9 citation statements)

References 21 publications

(8 reference statements)

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“…NHBD kidneys are routinely machine preserved. MP may reduce DGF and increase the rate of IF of renal allografts (25). In a meta-analysis of MP versus cold storage, MP leads to a 20% reduction in the incidence of DGF in HBDs and NHBDs.…”

Section: Discussionmentioning

confidence: 99%

Outcome of Nonheart‐Beating Donor Kidneys with Prolonged Delayed Graft Function after Transplantation

Renkens¹,

Rouflart²,

Christiaans³

et al. 2005

American Journal of Transplantation

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Nonheart-beating donor (NHBD) kidneys are frequently associated with delayed graft function (DGF), with a deleterious effect on kidney function and allograft survival. The influence and the duration of DGF on the outcome of NHBD kidneys are assessed. All recipients of an NHBD kidney in the period 1993-2003 were reviewed. Excluded from analysis were patients with primary nonfunction (PNF).One hundred and five patients with a functioning NHBD graft were reviewed: 23 (22%) had immediate function (group 1), 40 (38%) had DGF ≤ 2 weeks (group 2), 31 (30%) had DGF 15 days to 4 weeks (group 3) and 11 (10%) had DGF for >4 weeks (group 4). Creatinine clearance at 3 months was higher in groups 1 and 2 versus group 4 (p = 0.015 and p = 0.006, respectively) and was higher in group 2 versus group 4, at 1 year (p = 0.01). Graft survival was 95%, 98%, 97% and 89%, respectively, at 1 year and 95%, 85%, 77% and 89%, respectively, at 5 years, which was not significantly different.The duration of DGF in NHB kidneys has a negative effect on creatinine clearance, but no effect on graft survival.

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Section: Discussionmentioning

confidence: 99%

Outcome of Nonheart‐Beating Donor Kidneys with Prolonged Delayed Graft Function after Transplantation

Renkens¹,

Rouflart²,

Christiaans³

et al. 2005

American Journal of Transplantation

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“…MP may reduce the DGF of grafts retrieved from heart-beating donors and donation after cardiac death (DCD) donors by 20% (7)(8)(9)(10)(11)(12)(13)(14)(15)(16). Many authors have reported on the beneficial effects of MP on organs from marginal and DCD donors (33)(34)(35)(36)(37). Reports on renal allograft function in relation to preservation mode have focused on observations up to 12 months post-transplant (38)(39)(40)(41)(42) or have applied statistical simulation based on the relationship between function and graft survival and DGF (43)(44)(45)(46)(47) or the relationship between DGF and acute rejection (48).…”

Section: Discussionmentioning

confidence: 99%

Machine Perfusion Preservation Improves Renal Allograft Survival

Kwiatkowski

Wszoła

Kosieradzki

et al. 2007

American Journal of Transplantation

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Machine perfusion (MP) has been used as the kidney preservation method in our center for over 10 years. The first, small (n = 74) prospective, single-blinded randomized study comparing MP and Cold Storage (CS) showed that the incidence of delayed graft function was higher after CS. There have been no reports in the literature on the effect of storage modality on longterm function of renal allografts. This paper presents an analysis of long-term results of renal transplantation in 415 patients operated on between 1994 and 1999. Of those, 227 kidneys were MP-stored prior to KTx. The control group consisted of 188 CS kidney transplants. Kidneys were not randomized to MP or to CS. Donor demographics, medical and biochemical data, cold ischemia time, HLA match and recipient data were collected. Standard triple-drug immunosuppression was administered to both groups. Mortality, graft survival and incidence of return to hemodialysis treatment were analyzed. Despite longer cold ischemia time and poorer donor hemodynamics in MP group, 5-year Kaplan-Meier graft survival was better in MP-stored than in CS-stored kidneys (68.2% vs. 54.2%, p = 0.02). Conclusion: In this nonrandomized analysis, kidney storage by MP improved graft survival and reduced the number of patients who returned to dialysis.

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“…In contrast, perfusion with HTK may allow for higher flows and also for more efficient cooling than UW, and has demonstrated superior properties to preserve ATP concentrations in the mild hypothermic range of 15-32 ° C, which is typically found in the initially cooling process during organ flushing [19,20] . In a protocol that applies kidney machine perfusion prior to transplantation, Daemen et al [21] have already demonstrated a possible benefit of combining HTK and UW for kidney preservation in non-heart-beating donors after warm ischemia. However, it is difficult to precisely characterize the exact influence of preservation solutions in the complex setting of machine perfusion.…”

Section: Discussionmentioning

confidence: 99%

Impact of Organ Preservation Using HTK for Graft Flush and Subsequent Storage in UW in Rat Kidney Transplantation

Schmitz

Klawitter²,

Bendrick-Peart³

et al. 2006

Eur Surg Res

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Background: In kidney transplantation, preservation has a significant influence on organ function. Since previous reports have indicated a benefit of combining histidine-tryptophan-ketoglutarate (HTK) and University of Wisconsin (UW) solution, we evaluated the effects of initial flush with low viscosity HTK, followed by storage in UW. Material and Methods: Kidneys from inbred Lewis rats were procured using HTK or UW for initially perfusion and re-flushed after 30 min with either solution. In a third group, after perfusion with HTK, organs were re-flushed with UW. Organs were stored for 16–24 h (4°C). Study parameters were high-energy phosphates, histology, apoptosis, recipient survival and urine excretion of 15-F_2t-isoprostanes (oxidative stress marker). Results:Prior to transplantation, tissue ATP/ADP concentrations were: HTK/UW>UW-only >HTK-only. In transplanted kidneys, histological damage was highest after preservation in HTK-only. Twenty-four hours after transplantation (24 h cold ischemia time – CIT), cleaved-PARP was most abundant using UW-only. 16 h of CIT resulted in higher urine concentrations of isoprostanes in the order HTK-only (368 ± 308) > UW-only (157 ± 105) > HTK/UW (67 ± 26), and was lower in HTK/UW after 24 h of CIT (146 ± 38) vs. UW-only (507 ± 33 pg/mg creatinine). Survival (24 h CIT) was significantly reduced, and percentage of initial non-functioning (INF) kidneys highest in HTK-only (2.6 ± 0.3 days, 100%), compared to UW-only (13 ± 4.4 days, 75%) and HTK/UW (18.5 ± 4.6 days, 33%). Conclusions: In long-term preservation, UW is superior over HTK. However, our results indicate that perfusion with HTK prior to storage in UW may improve the results of UW alone which is reflected by better survival, lower rate of INF, higher cellular energy conservation and a decrease of free radicals.

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Effect of machine perfusion preservation on delayed graft function in non-heart-beating donor kidneys -early results

Cited by 11 publications

References 21 publications

Outcome of Nonheart‐Beating Donor Kidneys with Prolonged Delayed Graft Function after Transplantation

Outcome of Nonheart‐Beating Donor Kidneys with Prolonged Delayed Graft Function after Transplantation

Machine Perfusion Preservation Improves Renal Allograft Survival

Impact of Organ Preservation Using HTK for Graft Flush and Subsequent Storage in UW in Rat Kidney Transplantation

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