Kidney temperature course during living organ procurement and transplantation

Kuipers, Thomas; Hellegering, Joyce; Moumni, Mostafa El; Krikke, Christina; Haveman, Jan Willem; Berger, Stefan P.; Leuvenink, Henri G. D.; Pol, Robert A.

doi:10.1111/tri.12892

Cited by 18 publications

(10 citation statements)

References 23 publications

(28 reference statements)

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“…After the first cold flush in the donor, temperature drops to 10–20 °C, decreasing further to 1–3 °C during subsequent cold storage. During backtable preparations in preparation for transplantation, temperature increases slightly to 2–6 °C with a rapid increase to around 20 °C just before reperfusion in the recipient procedure and a subsequent full rewarming once vascular anastomoses are in place [10, 11].…”

Section: Introductionmentioning

confidence: 99%

Renal temperature reduction progressively favors mitochondrial ROS production over respiration in hypothermic kidney preservation

et al. 2019

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Background Hypothermia, leading to mitochondrial inhibition, is widely used to reduce ischemic injury during kidney preservation. However, the exact effect of hypothermic kidney preservation on mitochondrial function remains unclear. Methods We evaluated mitochondrial function [i.e. oxygen consumption and production of reactive oxygen species (ROS)] in different models (porcine kidney perfusion, isolated kidney mitochondria, and HEK293 cells) at temperatures ranging 7–37 °C. Results Lowering temperature in perfused kidneys and isolated mitochondria resulted in a rapid decrease in oxygen consumption (65% at 27 °C versus 20% at 7 °C compared to normothermic). Decreased oxygen consumption at lower temperatures was accompanied by a reduction in mitochondrial ROS production, albeit markedly less pronounced and amounting only 50% of normothermic values at 7 °C. Consequently, malondialdehyde (a marker of ROS-induced lipid peroxidation) accumulated in cold stored kidneys. Similarly, low temperature incubation of kidney cells increased lipid peroxidation, which is due to a loss of ROS scavenging in the cold. Conclusions Lowering of temperature highly affects mitochondrial function, resulting in a progressive discrepancy between the lowering of mitochondrial respiration and their production of ROS, explaining the deleterious effects of hypothermia in transplantation procedures. These results highlight the necessity to develop novel strategies to decrease the formation of ROS during hypothermic organ preservation. Electronic supplementary material The online version of this article (10.1186/s12967-019-2013-1) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Renal temperature reduction progressively favors mitochondrial ROS production over respiration in hypothermic kidney preservation

et al. 2019

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“…The temperature of the graft can rise rapidly to the metabolic threshold of 15 °C within 20 minutes of removing the kidney from ice. The heating of the graft increases cellular metabolism and leads to potentially harmful changes in the transplanted kidney (13). DGF is important since it may lead to longer hospital stay and need for dialysis, resulting in impaired renal allograft function and shorter survival (12).…”

Section: Discussionmentioning

confidence: 99%

Comparison of conventional and castroviejo needle holders in terms of vascular anastomosis time in renal transplant

et al. 2022

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Objective: It is important that the anastomosis time of renal vascular structures is not prolonged to minimize the potentially harmful effect of warm and cold ischemic times. This study aimed to determine the effect of the needle holder design used in vascular anastomosis during renal transplantation on the duration of anastomosis.Material and Methods: Patients that underwent renal transplantation at our clinic between September 2011 and February 2020, were divided into groups according to the two types of needle holders used in anastomoses. In Group 1, a conventional, Hegar-type, straight, 180-mm (7”) Ryder Diadust needle holder was used. In Group 2, a pen-type, straight, 215-mm (8 ½”) Castroviejo Durogrip TC micro needle holder was used. Demographic characteristics, vascular characteristics, and vascular anastomosis times were compared between the two groups. Results: A total of 75 patients were included in the study. There were 39 (52%) patients in Group 1 and 36 (48%) patients in Group 2. The mean number of arteries was 1.2 ± 0.4, and the mean arterial diameter was 5.3 ± 1.2 mm in the whole cohort, with no statistically significant difference between the two groups (p=0.196 and 0.304, respectively). The mean arterial anastomosis time was 15 ± 5.1 minutes in Group 1 and 10 ± 3.9 minutes in Group 2. The mean venous anastomosis times were 18.4 ± 6.1 in Group 1 and 14.7 ± 4 minutes in Group 2. In the statistical analysis, the arterial and vein anastomosis times were found to be significantly shorter in Group 2 than in Group 1 (p=0.038 and p=0.020, respectively).Conclusion: In our study, it was observed that the renal arterial and venous anastomosis times were significantly shorter in the group in which the pen-type Castroviejo needle holder was used in anastomoses performed during renal transplantation.

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“…If back-table preparation is not used, allograft transplantation with separate vascular anastomosis of the polar artery to the external iliac artery can prolong the warm ischemia time, resulting in an increased risk of acute tubular necrosis and decreased graft function [13]. Within 20 min of removing the kidney from the ice, the temperature can quickly increase above the metabolic threshold of 15 • C [14]. According to Weissenbacher et al, warm ischemia lasting more than 30 min needs to be considered as a major risk factor for the long-term results [15].…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of a Lower Polar Artery for Kidney Transplantation Using Donor Ovarian Vein: Case Report with Literature Review

et al. 2021

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Background: In the case of complicated kidney transplantation, when the accessory artery is severed, the main task is to decide whether to restore renal blood flow and which method should be used. In this report, we present a case of kidney transplantation with vascular reconstruction using an ovarian vein as an interposition graft between a larger branch of the main renal artery and the lower polar artery which was severed during kidney explantation. Case summary: Kidney transplantation using an ovarian vein was performed for a 34-year-old woman with end-stage renal disease on 1 April 2020 in the Hospital of Lithuanian university of health sciences (LUHS) Kaunas Clinics. A lower accessory renal artery was severed during kidney explantation. As the ovarian vein of the donor remained and matched the diameter of the severed vessel, it was decided to use it as an insertion between the main renal artery and the accessory renal artery of the inferior pole. The cold ischemic time was 770 min and the warm ischemic time was 37 min. A month after transplantation, the patient’s condition and daily urine output were normal and the serum creatinine level decreased rapidly. Fifteen months after the surgery, the function and structure of the transplant remained normal and there was no evidence of serious vascular complications on CT scans. This is the first case where graft function was verified after transplantation using three-dimensional CT angiography. Conclusions: If an inferior polar artery is severed, vascular reconstruction must be performed to preserve the function of the graft. Usually, the gonadal vein is available during donor nephrectomy; therefore, it can be explanted without additional difficulties or incisions. Although we have not reported any complications, further studies are recommended on the long-term outcomes of this alternative approach for the reconstruction of short renal arteries.

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Kidney temperature course during living organ procurement and transplantation

Cited by 18 publications

References 23 publications

Renal temperature reduction progressively favors mitochondrial ROS production over respiration in hypothermic kidney preservation

Renal temperature reduction progressively favors mitochondrial ROS production over respiration in hypothermic kidney preservation

Comparison of conventional and castroviejo needle holders in terms of vascular anastomosis time in renal transplant

Reconstruction of a Lower Polar Artery for Kidney Transplantation Using Donor Ovarian Vein: Case Report with Literature Review

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