Kidney perfusion

Jochmans, Ina; Nicholson, Michael L.; Hosgood, Sarah A.

doi:10.1097/mot.0000000000000405

Cited by 36 publications

(34 citation statements)

References 47 publications

(8 reference statements)

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“…While a growing body of data supports the use of NEVKP to condition and provide real-time evaluative data on the kidney allograft, more research is needed to define the appropriate perfusion conditions and protocols to maximize application of this nascent technology; the optimal preservation medium is one of the most important factors in question. 18,[32][33][34] In this study, we describe for the first time the efficacy of TA B L E 2 Baseline Remuzzi Scores in both groups, calculated by 2 consultant pathologists who were blinded to the donor types. Four different parameters were assessed in the scoring system: Glomerular global sclerosis, tubular atrophy, interstitial fibrosis, and vascular lesions (8).…”

Section: Discussionmentioning

confidence: 99%

Synthetic hemoglobin-based oxygen carriers are an acceptable alternative for packed red blood cells in normothermic kidney perfusion

Aburawi

Fontan

Karimian

et al. 2019

American Journal of Transplantation

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contributed equally to this work.Abbreviations: ADP, adenosine diphosphate; AMP, adenosine monophosphate; ATP, adenosine triphosphate; CIT, cold ischemia time; DBD, donation after brain death; DCD, donation after circulatory death; FENa, fractional excretion of sodium; HBOC, hemoglobin-based oxygen carrier; HMP, hypothermic machine perfusion; NEDS, New England Donor Services; NEVKP, normothermic ex vivo kidney perfusion; NMP, normothermic machine perfusion; PRBC, packed red blood cells; QAS, quality assessment score; SCS, static cold storage; WIT, warm ischemia time.Normothermic machine perfusion presents a novel platform for pretransplant assessment and reconditioning of kidney grafts. Maintaining the metabolic activity of a preserved graft at physiologic levels requires an adequate oxygen supply, typically delivered by crystalloid solutions supplemented with red blood cells. In this study, we explored the feasibility of using a synthetic hemoglobin-based oxygen carrier (HBOC) in human kidney normothermic perfusion. Fourteen discarded human kidneys were perfused for 6 hours at a mean temperature of 37°C using a pressurecontrolled system. Kidneys were perfused with a perfusion solution supplemented with either HBOC (n = 7) or packed red blood cells (PRBC) (n = 7) to increase oxygencarrying capacity. Renal artery resistance, oxygen extraction, metabolic activity, energy stores, and histological features were evaluated. Throughout perfusion, kidneys from both groups exhibited comparable behavior regarding vascular flow (P = .66), oxygen consumption (P = .88), and reconstitution of tissue adenosine triphosphate (P = .057). Lactic acid levels were significantly higher in kidneys perfused with PRBC (P = .007). Histological findings were comparable between groups, and there was no evidence of histological damage caused by the HBOC. This feasibility experiment demonstrates that a HBOC solution can offer a logistically more convenient off-theshelf alternative to PRBC in normothermic machine perfusion of human kidneys. K E Y W O R D Sbasic (laboratory) research/science, kidney transplantation/nephrology, organ perfusion and preservation, organ procurement and allocation, tissue/organ engineering, translational research/science | 2815 ABURAWI et Al.

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Section: Discussionmentioning

confidence: 99%

Synthetic hemoglobin-based oxygen carriers are an acceptable alternative for packed red blood cells in normothermic kidney perfusion

Aburawi

Fontan

Karimian

et al. 2019

American Journal of Transplantation

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“…Kidneys not suitable for transplantation have been normothermically perfused for 24 hours, making use of urine recirculation, though not transplanted [55]. Prolonged normothermic perfusion might offer improved preservation and assessment as well as time to repair organ injury [56].…”

Section: Normothermic Kidney Perfusionmentioning

confidence: 99%

Kidney Perfusion as an Organ Quality Assessment Tool—Are We Counting Our Chickens Before They Have Hatched?

Beule

Jochmans

2020

JCM

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The final decision to accept an organ for transplantation remains a subjective one. With “poor organ quality” commonly cited as a major reason for kidney discard, accurate, objective, and reliable quality assessment is essential. In an era of increasingly higher-risk deceased donor kidneys, the catch is to accept those where the risk–benefit scale will tip in the right direction. Currently available assessment tools, such as risk-scores predicting outcome and zero-time biopsy, perform unsatisfactory, and assessment options during static cold storage are limited. Kidney perfusion technologies are finding their way into clinical practice, and they bring a new opportunity to assess kidney graft viability and quality, both in hypothermic and normothermic conditions. We give an overview of the current understanding of kidney viability assessment during ex situ kidney perfusion. A pragmatic framework to approach viability assessment is proposed as an interplay of three different compartments: the nephron, the vascular compartment, and the immune compartment. Although many interesting ways to assess kidney injury and function during perfusion have been proposed, none have reached the stage where they can reliably predict posttransplant outcome. Larger well-designed studies and validation cohorts are needed to provide better guidance.

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“…These approaches could be used alone or in combination, leading to individualized perfusion strategies, tailored to the quality of the donated kidneys and applied throughout the entire period of preservation or as a period of ex situ reconditioning and repair in the transplant centre or in a purpose-build organ reconditioning facility. While many questions surrounding the use of machine perfusion remain unanswered, it is clear that the days of static cold storage are rapidly coming to an end [ 24 ].…”

Section: Kidney Machine Perfusion Strategiesmentioning

confidence: 99%

Recent advances in kidney transplantation: a viewpoint from the Descartes advisory board*

Abramowicz

Oberbauer

Heemann

et al. 2018

Nephrology Dialysis Transplantation

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Transplantation medicine is a rapidly evolving field. Keeping afloat of the published literature to offer the best clinical care to our patients is a daunting task. As part of its educational mission, the Descartes advisory board identified seven topics in kidney transplantation where there has been substantial progresses over the last years: kidney allocation within Eurotransplant; kidney exchange strategies; kidney machine perfusion strategies; the changing landscape of anti-human leukocyte antigen (HLA) antibodies; the new immunosuppressive drugs in the pipeline; strategies for immunosuppression minimization; and the continuous enigma of focal segmental glomerular sclerosis recurrence after transplantation. Here, we have summarized the main knowledge and the main challenges of these seven topics with the aim to provide transplant professionals at large with key bullet points to successfully understand these new concepts.

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Kidney perfusion

Abstract: A great deal of research is still needed to optimize and logistically place hypothermic and normothermic perfusion technologies. In the future, we may progress toward organ-tailored preservation whereby high-risk kidneys can undergo assessment and repair before transplantation.

Cited by 36 publications

References 47 publications

Synthetic hemoglobin-based oxygen carriers are an acceptable alternative for packed red blood cells in normothermic kidney perfusion

Synthetic hemoglobin-based oxygen carriers are an acceptable alternative for packed red blood cells in normothermic kidney perfusion

Kidney Perfusion as an Organ Quality Assessment Tool—Are We Counting Our Chickens Before They Have Hatched?

Recent advances in kidney transplantation: a viewpoint from the Descartes advisory board*

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