Machine perfusion for kidneys: how to do it at minimal cost

Abstract

Due to a shortage of organs for transplantation, many centres use marginal grafts to increase their donor pool. As kidneys from non-heart-beating donors (NHBD) have sustained initial ischaemic damage, their viability is difficult to predict. Hypothermic pulsatile perfusion has not only been used to improve the condition of such grafts, but also allows viability assessment. Suitable systems are becoming more readily available, but they are expensive. We have used existing dialysis equipment with modified sterilised inserts to create a pulsatile hypothermic perfusion system. With this system, 41 NHBD kidneys were perfused for up to 8 h; their intravascular renal resistance (IRVR), flow characteristics as well as glutathione S transferase (GST) measurements were performed to assess viability. This hypothermic pulsatile perfusion system is now an integral component of our NHBD programme.

Histidine-induced injury to cultured liver cells, effects of histidine derivatives and of iron chelators

“…For the same reason, the injury occurring during rewarming after cold incubation was also largely reduced in the Nα-acetyl-Lhistidine-containing modified KH buffer, compared to the regular KH buffer, in the absence of iron chelators (in the chloride-poor L-histidine-containing solutions, most cells were already dead before rewarming due to histidine toxicity). Currently, continuous machine perfusion, one of the first methods to preserve kidney grafts, has gained renewed interest, particularly for kidney preservation, on the Research Article 203 background of organ shortage and the increased use of marginal organs [28][29][30][31]. Continuous machine perfusion allows the delivery of oxygen during storage and thus decreases ischemic injury.…”

Renal transplants from non‐heart beating paracetamol overdose donors

“…The donor was then transferred to theatre for formal donor nephrectomy. The NHBD kidneys are machine perfused prior to transplantation using the Newcastle hypothermic preservation system (5–6). Viability assessment consists of evaluation of machine perfusion characteristics and perfusate analysis.…”

Leucocyte Depletion Improves Renal Function in Porcine Kidney Hemoreperfusion Through Reduction of Myeloperoxidase+ Cells, Caspase-3, IL-1β, and Tubular Apoptosis

“…It has been recognized that porcine kidneys have anatomical and physiologic characteristics that resemble those of adult human kidneys [13]. Moreover, in isolated perfusion experiments porcine kidneys remain viable much longer than rodent kidneys [14,15]. Therefore, normothermic hemoperfusion may be a better approach for kidney preservation and could be potentially applied in clinical practice.…”