Kidney temperature course during living organ procurement and transplantation

Abstract

Little is known about the actual kidney graft temperature during the 2nd warm ischemia time (WIT2). We aimed to determine the actual temperature course of the WIT2, with emphasis on the 15°C metabolic threshold. Data of 152 consecutive adult living donor kidney transplantations were collected. The mean WIT2 was 41.3 AE 10.1 (SD) minutes with a temperature of 5.4°C at baseline which gradually increased to 13.7, 17.4, and 20.2°C after 10, 20, and 30 min, respectively. The percentage of kidneys with a temperature of 15°C or higher was 81.2% after 20 min and 97.5% after 30 min. Duration of surgery (95% CI: À0.017 to À0.002, P = 0.02), multiple veins (95% CI: 0.0003-2.720, P = 0.05) and WIT2 (95% CI: 0.016-0.099, P = 0.006) were associated with a rapid temperature increase. No correlation could be determined between a rapid temperature rise and diminished graft function. This study showed a rapid increase in kidney temperature during WIT2, wherein the 15°C threshold was reached within 20 min in more than 80% of the patients.

Kidney temperature during living donor kidney transplantation is associated with short‐term measured glomerular filtration rate – a prospective study

“…This relatively large, single‐centre, prospective study reveals a potentially modifiable factor to achieve optimal kidney transplant function. Therefore, the reported WIT2 should perhaps not be equal to anastomosis time, but rather to the duration that the kidney temperature has surpassed a certain temperature, that is the metabolic threshold of 15 °C, as suggested before . Given these findings, it would be of interest to investigate the medical consequences of the presented association.…”

“…A comprehensive description of the kidney transplantation procedure was described by Kuipers et al . .…”

Frailty has a significant influence on postoperative complications after kidney transplantation-a prospective study on short-term outcomes

“…The CCI takes the quantity of appearance of each complication into account, using a specific calculation that yields a score from 0 to 100, thereby giving a very detailed assessment for every patient. The kidney transplantation procedure, as performed at our hospital, has been published previously by our group . Our primary outcome measure was 30‐day postoperative complications according to the CCI.…”

Author response to: Comment on: Effect of donor nephrectomy time during circulatory-dead donor kidney retrieval on transplant graft failure

“…Prolonging the donor back‐table phase with the kidney left relatively warm likely exaggerates the ischaemic insult. During recipient back‐table work, an increase in kidney temperature has been demonstrated in a study on living donor kidney transplantation: temperature rose from 1·6 ± 1·5 °C (range − 0·7 to 8·4 °C) after cold storage to 4·2 ± 2·8 °C (range 0·4–13·8 °C) at the end of back‐table preparation.…”

“…Exposure of the organ to lukewarm temperatures for several tens of minutes is presumed to be the causative factor as metabolic rate is linked to temperature. It has been shown that temperature decreases slowly after cold flush in the donor and rises quickly once the organ is removed from the ice at time of implantation. Prolonging the donor back‐table phase with the kidney left relatively warm likely exaggerates the ischaemic insult.…”