Influence of Pulsatile Perfusion Preservation on Outcomes in Kidney Transplantation from Expanded Criteria Donors

Stratta, Robert J.; Moore, P. R.; Farney, Alan C.; Rogers, Jeffrey; Hartmann, Erika; Reeves‐Daniel, Amber; Gautreaux, Michael D.; Iskandar, Samy S.; Adams, Patricia L.

doi:10.1016/j.jamcollsurg.2007.01.032

Cited by 93 publications

(87 citation statements)

References 33 publications

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“…A non-ischemic kidney (NI) was defined as immediate perfusion with modified UW cold preservation solution and transplanted after minimal cold perioperative time (31 ± 1 min). An ischemic kidney (I) was defined by 30 min of warm ischemia followed by perfusion and storage in ice-cold preservation for 24 h. This duration of cold storage and thus ischemia is common in clinical transplantation [32]. …”

Section: Methodsmentioning

confidence: 99%

The Contribution of Podocytes to Chronic Allograft Nephropathy

Pippin

Kumar

Stein

et al. 2008

Nephron Exp Nephrol

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Background: Progressive proteinuria and glomerulosclerosis characterize chronic allograft nephropathy. However, the causes are not fully elucidated. Podocytes function to prevent proteinuria; injury to this glomerular cell leads to glomerulosclerosis. The potential role of podocytes in the failing transplanted kidney is unknown. A rat model of kidney transplantation, characterized by proteinuria and glomerulosclerosis, was utilized to examine the potential role of podocytes. Methods: Archival tissue was examined from allografts (Dark Agouti kidneys transplanted into operationally tolerant Albino Surgery rats), isografts (Dark Agouti) and controls (Dark Agouti: age-matched or after unilateral nephrectomy). The number of podocytes (by WT-1 staining) as well as the podocyte proteins podocin, nephrin and synaptopodin (by immunostaining) were measured at days 0, 2, 6 and at 6 months after transplantation. Changes in these parameters were compared between groups and correlated with urinary protein excretion. Results: At 6 months, podocyte number was reduced in allografted kidneys, accompanied by a decrease in nephrin and synaptopodin, but not podocin staining. Remnant kidneys in the uninephrectomized rats also showed a decreased podocyte number but no change in podocyte protein staining. Podocyte loss in allografts was established on day 6, whereas a decrease in nephrin and synaptopodin was not evident until 6 months. In contrast, podocyte number and protein staining was decreased but not significantly so in remnant and isografted kidneys. Conclusion: A decrease in the slit diaphragm proteins, nephrin and synaptopodin, is a component of chronic allograft pathology.

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Section: Methodsmentioning

confidence: 99%

The Contribution of Podocytes to Chronic Allograft Nephropathy

Pippin

Kumar

Stein

et al. 2008

Nephron Exp Nephrol

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“…16,25 Despite longer cold ischemia times, recipients of ECD kidneys managed with pulsatile perfusion preservation had similar survival and functional outcomes, but experienced a marked reduction in the rate of DGF. 26 Not all authors agree. 27 In our cohort, 27/111 were machine perfused.…”

Section: Discussionmentioning

confidence: 99%

Early Allograft Biopsies Performed During Delayed Graft Function May Not Be Necessary Under Thymoglobulin Induction

Ortíz

Parsikia²,

Mumtaz³

et al. 2012

Exp Clin Transplant

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Objectives: Delayed graft function affects up to 50% of kidney transplant recipients. Some guidelines recommend surveillance biopsies beginning 7 days after engraftment. This may be unnecessary with anti-thymocyte globulin induction. Materials and Methods: We conducted a retrospective study of deceased-donor renal transplant recipients with delayed graft function. Results: One hundred eleven patients met the inclusion criteria. The incidence of rejections during delayed graft function was 2.7%. They were diagnosed between 9 and 11 days after transplant. The subsequent incidence of rejection at 12-month follow-up was 13.5% (n=15). The median time to rejection after transplant was 10 weeks. Fourteen of 15 patients had subtherapeutic immunosuppression. The only risk factor associated with later rejection after delayed graft function was use of donors after cardiac death. Conclusions: Early rejection during delayed graft function with anti-thymocyte globulin induction and maintenance immunosuppression with tacrolimus, mycophenolate mofetil, and steroids is rare. When later rejection occurs, it is at a median of 10 weeks after a transplant. Two of the 3 early rejections were antibody mediated. Later rejections were associated with subtherapeutic immunosuppression and donors after cardiac death. Biopsies need not be performed during the early postoperative period when anti-thymocyte globulin is used with tacrolimus, mycophenolate mofetil, and steroids.

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“…Studies have reported both reduced DGF and improved graft survival using HMP to preserve deceased-donor kidneys. [20][21][22][23][24][25][26][27][28][29] Others studies have suggested that HMP may permit longer CIT without increasing DGF rates. 23,30 The present study supports this concept.…”

Section: Discussionmentioning

confidence: 99%

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2015

Exp Clin Transplant

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Objectives: The logistics of deceased-donor renal transplants are largely affected by cold ischemia time. However, to attain successful outcomes, other issues must be considered. Extending cold ischemia time to accommodate these issues would be valuable. We investigated the role of hypothermic machine perfusion to extend cold ischaemia time. Materials and Methods: Deceased-donor kidneys were allocated to a storage method, depending on predicted time to operation. Kidneys to be transplanted from 8:00 AM to 8:00 PM in the transplant room remained in static cold storage. If predicted operating time was out of hours, the kidney was transferred to hypothermic machine perfusion and transplanted at the earliest opportunity on the dedicated transplant list. Results: There were 74 kidneys transplanted from hypothermic machine perfusion and 101 kidneys from static cold storage. Median cold ischemia time was 23.85 hours in the hypothermic machine perfusion group, compared with 13 hours in the static cold storage group (P ≤ .0001). There were 20 kidneys (27%) from hypothermic machine perfusion that had delayed graft function, compared with 47 kidneys (47%) in the static cold storage group (P = .012). There were no other significant differences in graft or postoperative complications. Conclusions:This study demonstrated that improved early graft outcomes can be achieved following longer cold ischemia time by using hypothermic machine perfusion rather than static cold storage. This effect is likely multifactorial including the inherent effects of hypothermic machine perfusion, improved recipient preparation, and possibly better perioperative conditions.

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Influence of Pulsatile Perfusion Preservation on Outcomes in Kidney Transplantation from Expanded Criteria Donors

Cited by 93 publications

References 33 publications

The Contribution of Podocytes to Chronic Allograft Nephropathy

The Contribution of Podocytes to Chronic Allograft Nephropathy

Early Allograft Biopsies Performed During Delayed Graft Function May Not Be Necessary Under Thymoglobulin Induction

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