Experiences Learned in the Successful Establishment of a Nonheart Beating Donor Program for Renal Transplantation

Talbot, David; Shenton, B. K.; Buckley, P.; Gok, MA

doi:10.1097/01.ju.0000086774.12582.0f

Cited by 18 publications

(14 citation statements)

References 8 publications

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“…Nonetheless, given the clear need to reduce unnecessary organ refusals, a more forwardthinking hypothesis is that biomarkers like perfusate pi-GST might differentiate between recoverable versus unrecoverable kidney injury more precisely than current perfusion parameters. Many OPOs and prospective transplant centers pay close attention to perfusion parameters at the time of organ offer (12,(15)(16)(17). Consequently, most observational studies that assess the utility of perfusion parameters in predicting allograft outcomes are limited by potential selection bias and confounding by indication, and the current study is no different in this regard.…”

Section: Discussionmentioning

confidence: 92%

Glutathione S-Transferase Iso-Enzymes in Perfusate From Pumped Kidneys Are Associated With Delayed Graft Function.

Hall

Bhangoo

Reese³

et al. 2014

Transplantation

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Accurate and reliable assessment tools are needed in transplantation. The objective of this prospective, multicenter study was to determine the associations of the alpha and pi iso-enzymes of glutathione S-transferase (GST), measured from perfusate solution at the start and end (base and post) of kidney allograft machine perfusion, with subsequent delayed graft function (DGF). We also compared GST iso-enzyme perfusate levels from discarded versus transplanted kidneys. A total of 428 kidneys were linked to outcomes as recorded by the United Network of Organ Sharing. DGF, defined as any dialysis in the first week of transplant, occurred in 141 recipients (32%). Alpha and pi-GST levels significantly increased during machine perfusion. The adjusted relative risks (95% confidence interval) of DGF with each log-unit increase in base and post pi-GST were 1.14 (1.0-1.28) and 1.33 (1.02-1.72), respectively. Alpha-GST was not independently associated with DGF. There were no significant differences in GST values between discarded and transplanted kidneys, though renal resistance was significantly higher in discarded kidneys. We NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript found pi-GST at the end of machine perfusion to be independently associated with DGF. Further studies should elucidate the utility of GST for identifying injured kidneys with regard to organ allocation, discard and recipient management decisions.

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Section: Discussionmentioning

confidence: 92%

Glutathione S-Transferase Iso-Enzymes in Perfusate From Pumped Kidneys Are Associated With Delayed Graft Function.

Hall

Bhangoo

Reese³

et al. 2014

Transplantation

View full text Add to dashboard Cite

show abstract

“…Nonetheless, given the clear need to reduce unnecessary organ refusals, a more forward‐thinking hypothesis is that biomarkers like perfusate pi‐GST might differentiate between recoverable versus unrecoverable kidney injury more precisely than current perfusion parameters. Many OPOs and prospective transplant centers pay close attention to perfusion parameters at the time of organ offer . Consequently, most observational studies that assess the utility of perfusion parameters in predicting allograft outcomes are limited by potential selection bias and confounding by indication, and the current study is no different in this regard.…”

Section: Discussionmentioning

confidence: 92%

Glutathione S-Transferase Iso-Enzymes in Perfusate From Pumped Kidneys Are Associated With Delayed Graft Function

Hall

Bhangoo

Reese

et al. 2014

American Journal of Transplantation

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Accurate and reliable assessment tools are needed in transplantation. The objective of this prospective, multicenter study was to determine the associations of the alpha and pi iso-enzymes of glutathione S-transferase (GST), measured from perfusate solution at the start and end (base and post) of kidney allograft machine perfusion, with subsequent delayed graft function (DGF). We also compared GST iso-enzyme perfusate levels from discarded versus transplanted kidneys. A total of 428 kidneys were linked to outcomes as recorded by the United Network of Organ Sharing. DGF, defined as any dialysis in the first week of transplant, occurred in 141 recipients (32%). Alpha and pi-GST levels significantly increased during machine perfusion. The adjusted relative risks (95% confidence interval) of DGF with each log-unit increase in base and post pi-GST were 1.14 (1.0-1.28) and 1.33 (1.02-1.72), respectively. Alpha-GST was not independently associated with DGF. There were no significant differences in GST values between discarded and transplanted kidneys, though renal resistance was significantly higher in discarded kidneys. We found pi-GST at the end of machine perfusion to be independently associated with DGF. Further studies should elucidate the utility of GST for identifying injured kidneys with regard to organ allocation, discard and recipient management decisions.

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“…Esto nos permitiría seleccionar para su trasplante solamente los órganos con los que previsiblemente se va a alcanzar un éxito clínico. Un hecho inevitable con la perfusión es el incremento de peso del injerto, se produce a consecuencia de la fuga de líquido de perfusión de los capilares provocando edema intersticial 24 . Se considera aceptable un incremento de peso menor al 40% del órgano.…”

Section: Discussionunclassified

“…y un patrón de RVR con tendencia ascendente 31 . Otros autores consideran como un parámetro favorable y suficiente que la RVR se reduzca durante el tiempo de perfusión 24 . Los valores elevados de RVR obtenidos durante la preservación hipotérmica se han relacionado con la presencia de edema intersticial o microtrombosis 34 .…”

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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Experiences Learned in the Successful Establishment of a Nonheart Beating Donor Program for Renal Transplantation

Abstract: If such criteria are adhered to, graft survival becomes reliable from such donors.

Cited by 18 publications

References 8 publications

Glutathione S-Transferase Iso-Enzymes in Perfusate From Pumped Kidneys Are Associated With Delayed Graft Function.

Glutathione S-Transferase Iso-Enzymes in Perfusate From Pumped Kidneys Are Associated With Delayed Graft Function.

Glutathione S-Transferase Iso-Enzymes in Perfusate From Pumped Kidneys Are Associated With Delayed Graft Function

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

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