Kidney preservation in the next millenium

Stubenitsky, Bart M.; Booster, M. H.; Nederstigt, A. P.; Kievit, J.K.; Jacobs, R. W. A.; Kootstra, G.

doi:10.1007/s001470050191

Cited by 12 publications

(8 citation statements)

References 67 publications

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“…Several studies have shown that NMP is superior to HMP or CS preservation of severely WI-damaged NHB donor kidneys [72][73][74][75][76][77]. Moreover, NMP may offer a more reliable method for ex vivo pretransplant functional assessment of a kidney graft based on urine production, perfusion dynamics and biochemical injury markers in the perfusate [78]. Ex vivo functional assessment of NHB pulmonary grafts, as proposed by several groups, also depends on adequate NMP, combined with artificial ventilation [79,80].…”

Section: Preservation Techniquesmentioning

confidence: 99%

Non-heart beating organ donation: overview and future perspectives

2007

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Summary New indications for organ transplantation combined with a stagnating number of available donor grafts have severely lengthened the waiting list for almost all types of transplantations. This has led to a renewed interest in non‐heart beating (NHB) donation, as a possible solution to bridge the gap between supply and demand. In this review, we present an overview of current NHB donation practice, outcome, existing problems and future perspectives. We focus on possible improvements in donor management, recipient care and new methods of organ preservation that may be better suited for these marginal organs. Successful institution of NHB protocols depends on adapting current transplantation practice at all levels, which is one of the greatest challenges for researchers and professionals in this interesting re‐emerging field.

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Section: Preservation Techniquesmentioning

confidence: 99%

Non-heart beating organ donation: overview and future perspectives

2007

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“…For the past decades, severe hypothermia has also represented the foundation of kidney preservation in clinical transplantation, although some authors have advocated the use of more moderate levels of hypothermia to prevent ischemic damage during transplantation (8).…”

mentioning

confidence: 99%

Morphologic changes in tubular cells from in situ kidneys following experimental hypothermia and rewarming

Tveita

Johansen

Lien

et al. 2005

APMIS

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Although renal failure may occur following rewarming from deep accidental hypothermia, this subject has received little attention in experimental hypothermia and clinical case reports. In order to explore the integrity of hypothermic and posthypothermic renal morphology we used an experimental animal model of accidental hypothermia where the heart supports the circulation throughout cooling and rewarming without accompanying cardioplegia or ischemia. Ultrastructural changes in renal tubular cells from three groups of pentobarbital anesthetized Wistar rats: 1) controls (n=6) maintained at 37 degrees C for 4 h, 2) hypothermic rats (n=6) core-cooled and maintained at 15-13 degrees C for 4 h, and 3) rewarmed rats (n=10), were studied as a sensitive indicator of renal damage. Electron micrographs (EM) from hypothermic kidneys showed rounded up mitochondria with loss of contrast. These changes were observed in several though not all of the biopsies, but they were found in all kidneys. Areas exhibiting focal tubular necrosis were seen on most EM from three of these kidneys. EM from rewarmed kidneys showed alterations of mitochondrial ultrastructure with similarities to those observed after hypothermia, but in general the changes were more prominent. Extracellular edema, intracellular edema, swelling of mitochondria, margination of chromatin, necrosis of single tubular cells, and disrupting necrotic debris into tubular lumen could be found in micrographs from 7 of the 10 kidneys examined. Rewarming from experimental hypothermia, without episodes of ischemia or hypoxia, thus induces ultrastructural changes in renal tubular cells similar to changes observed in acute tubular necrosis, associated with renal failure.

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“…Another approach to stimulate anabolic metabolism during preservation in order to prolong adequate preservation time, could be the perfusion of organs at warmer temperatures [28]. In an environment where renal metabolism is continuously supported instead of inhibited, and waste products are removed, the limitations of static storage may be avoided.…”

Section: Effect Of CI On Organ Functionmentioning

confidence: 99%

Deletrious effect of prolonged cold ischemia on renal function

Stubenitsky¹,

Brasile²,

Booster³

et al. 2001

Transplant International

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The detrimental effect of prolonged cold ischemia (CI) on posttransplant renal function has long been recognized. However, the cellular consequences of CI have not been clearly defined. This study describes a model for the identification of CI-induced injury by evaluating ex-vivo renal metabolism and function prior to reperfusion. Small bovine kidneys were cold stored in Viaspan for 24-, 48-, 72-, and 96 h. Kidneys were then warm perfused (32 "C) using Exsangiunous Metabolic Support (EMS) technology and evaluated for oxidative metabolism, vascular dynamics and function. Oxygen consumption, vascular resistance, and diuresis were stable in kidneys with CI up to 48 h. After 72-and 96 h of CI, vascular resistance was increased while oxygen consumption and diuresis were reduced ( P < 0.0.5). Glomerular filtration rate was diminished at CI greater than 24 h ( P < 0.0.5). Results show that function was compromised with CI greater than 24 h and preceded the loss of cell viability following 48 h of CI.

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Kidney preservation in the next millenium

Cited by 12 publications

References 67 publications

Non-heart beating organ donation: overview and future perspectives

Non-heart beating organ donation: overview and future perspectives

Morphologic changes in tubular cells from in situ kidneys following experimental hypothermia and rewarming

Deletrious effect of prolonged cold ischemia on renal function

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