Hypothermic Machine Perfusion as an Alternative to Biopsy Assessment in Transplantation of Kidneys Donated After Cardiocirculatory Death: A Pilot Study

Bissolati, Massimiliano; Pindozzi, Fioralba; Guarneri, Giovanni; Adamenko, Olga; Giannone, Fabio; Mazza, M.; Maggi, G; Rosati, Riccardo; Secchi, Antonio; Socci, C.

doi:10.1016/j.transproceed.2019.02.069

Cited by 7 publications

(5 citation statements)

References 19 publications

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“…The established approaches showed variable degrees of success in improving outcomes, as evidenced by several trials and meta-analyses, especially in organs from high-risk donors [ 15 , 17 , 20 , 21 , 22 ]. They have also introduced additional ways of assessing the viability and function of organs pre-transplant, the potential of optimizing organs by reconditioning, and ways of overcoming logistical challenges by prolonging the preservation period while maintaining better organ function [ 23 , 24 ]. Since a comparison of all clinical available perfusion approaches in kidney transplantation is lacking, this review was conducted to highlight the advantages and disadvantages of the different perfusion techniques.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Kidney Perfusion Techniques in Transplantation from Deceased Donors: A Systematic Review and Meta-Analysis

Ghoneima

Silva²,

Gosteli

et al. 2023

JCM

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The high demand for organs in kidney transplantation and the expansion of the donor pool have led to the widespread implementation of machine perfusion technologies. In this study, we aim to provide an up-to-date systematic review of the developments in this expanding field over the past 10 years, with the aim of answering the question: “which perfusion technique is the most promising technique in kidney transplantation?” A systematic review of the literature related to machine perfusion in kidney transplantation was performed. The primary outcome measure was delayed graft function (DGF), and secondary outcomes included rates of rejection, graft survival, and patient survival rates after 1 year. Based on the available data, a meta-analysis was performed. The results were compared with data from static cold storage, which is still the standard of care in many centers worldwide. A total of 56 studies conducted in humans were included, and 43 studies reported outcomes of hypothermic machine perfusion (HMP), with a DGF rate of 26.4%. A meta-analysis of 16 studies showed significantly lower DGF rates in the HMP group compared to those of static cold storage (SCS). Five studies reported outcomes of hypothermic machine perfusion + O2, with an overall DGF rate of 29.7%. Two studies explored normothermic machine perfusion (NMP). These were pilot studies, designed to assess the feasibility of this perfusion approach in the clinical setting. Six studies reported outcomes of normothermic regional perfusion (NRP). The overall incidence of DGF was 71.5%, as it was primarily used in uncontrolled DCD (Maastricht category I-II). Three studies comparing NRP to in situ cold perfusion showed a significantly lower rate of DGF with NRP. The systematic review and meta-analysis provide evidence that dynamic preservation strategies can improve outcomes following kidney transplantation. More recent approaches such as normothermic machine perfusion and hypothermic machine perfusion + O2 do show promising results but need further results from the clinical setting. This study shows that the implementation of perfusion strategies could play an important role in safely expanding the donor pool.

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Section: Introductionmentioning

confidence: 99%

Outcomes of Kidney Perfusion Techniques in Transplantation from Deceased Donors: A Systematic Review and Meta-Analysis

Ghoneima

Silva²,

Gosteli

et al. 2023

JCM

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“…Although many have advocated against discarding kidneys strictly based on parameters during HMP, 10,17–20 the clinical significance of these parameters is far to be fully elucidated especially in uDCDs who are characterized by quite a long ischemic time and by an ischemic-reperfusion injury, difficult to assess and quantify.…”

Section: Discussionmentioning

confidence: 99%

“…Cold ischemia time (CIT) was calculated from the start of abdominal perfusion during procurement until the end of machine perfusion. 18…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2020

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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.

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“…On the other hand, the Montreal group showed that a renal resistance <0.2 resulted in a 5-year graft survival of 93% which might render renal resistance useful as re-assurance tool for accepting marginal kidneys due to its reasonably faire negative predictive value [83]. Recent date from the Milan group indicated for the renal resistance trend is more predictive of post-transplantation outcome than pre-transplantation biopsy evaluation, suggesting that renal resistance to be a less invasive assessment tool better reflecting cortical status [84,85].…”

Section: Mechanical Perfusion Parameters and Biomarkers As Predictors Of Outcome 71 Mechanical Perfusion Parametersmentioning

confidence: 99%

Simply Adding Oxygen during Hypothermic Machine Perfusion to Combat the Negative Effects of Ischemia-Reperfusion Injury: Fundamentals and Current Evidence for Kidneys

2021

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The use of high-risk renal grafts for transplantation requires optimization of pretransplant preservation and assessment strategies to improve clinical outcomes as well as to decrease organ discard rate. With oxygenation proposed as a resuscitative measure during hypothermic machine preservation, this review provides a critical overview of the fundamentals of active oxygenation during hypothermic machine perfusion, as well as the current preclinical and clinical evidence and suggests different strategies for clinical implementation.

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Hypothermic Machine Perfusion as an Alternative to Biopsy Assessment in Transplantation of Kidneys Donated After Cardiocirculatory Death: A Pilot Study

Cited by 7 publications

References 19 publications

Outcomes of Kidney Perfusion Techniques in Transplantation from Deceased Donors: A Systematic Review and Meta-Analysis

Outcomes of Kidney Perfusion Techniques in Transplantation from Deceased Donors: A Systematic Review and Meta-Analysis

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

Simply Adding Oxygen during Hypothermic Machine Perfusion to Combat the Negative Effects of Ischemia-Reperfusion Injury: Fundamentals and Current Evidence for Kidneys

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