Normothermic machine perfusion for the assessment and transplantation of declined human kidneys from donation after circulatory death donors

Abstract

BackgroundA significant proportion of donation after circulatory death (DCD) kidneys are declined for transplantation because of concerns over their quality. Ex vivo normothermic machine perfusion (NMP) provides a unique opportunity to assess the quality of a kidney and determine its suitability for transplantation.MethodsIn phase 1 of this study, declined human DCD kidneys underwent NMP assessment for 60 min. Kidneys were graded 1–5 using a quality assessment score (QAS) based on macroscopic perfusion, renal blood flow and urine output during NMP. In phase 2 of the study, declined DCD kidneys were assessed by NMP with an intention to transplant them.ResultsIn phase 1, 18 of 42 DCD kidneys were declined owing to poor in situ perfusion. After NMP, 28 kidneys had a QAS of 1–3, and were considered suitable for transplantation. In phase 2, ten of 55 declined DCD kidneys underwent assessment by NMP. Eight kidneys had been declined because of poor in situ flushing in the donor and five of these were transplanted successfully. Four of the five kidneys had initial graft function.ConclusionNMP technology can be used to increase the number of DCD kidney transplants by assessing their quality before transplantation.

Emerging technologies in organ preservation, tissue engineering and regenerative medicine: a blessing or curse for transplantation?

“…Because of the large number of perfusion systems and preclinical and clinical trials, we exemplarily discuss the potential of machine perfusion in the setting of liver perfusion in the following section. Various reviews and reports on perfusion systems for the heart , lung , kidney , and initial studies in pancreas and VCA are available elsewhere.…”

Dissemination of a novel organ perfusion technique: ex vivo normothermic perfusion of deceased donor kidneys

“…Studies suggest that EVNP reduces DGF in extended criteria donor kidneys when compared to historical controls preserved using cold storage alone . Furthermore, the Cambridge group has reported the use of EVNP in successfully transplanting human kidneys that were deemed untransplantable and declined by all UK transplant units . EVNP may therefore be able to reduce the rate of deceased donor kidneys that are unnecessarily discarded .…”

“…EVNP may therefore be able to reduce the rate of deceased donor kidneys that are unnecessarily discarded . However, EVNP is a technically complex procedure, and reports have been published from only 2 groups to date . Like any new innovation in surgery, it is essential that novel perfusion technologies are widely translatable to other units.…”

“…8 Furthermore, the Cambridge group has reported the use of EVNP in successfully transplanting human kidneys that were deemed untransplantable and declined by all UK transplant units. 9 EVNP may therefore be able to reduce the rate of deceased donor kidneys that are unnecessarily discarded. 6,10 However, EVNP is a technically complex procedure, and reports have been published from only 2 groups to date.…”

Use of ex vivo normothermic machine perfusion after normothermic regional perfusion to salvage a poorly perfused DCD kidney

“…One initiative has been the introduction of normothermic perfusion technologies, which reduce the deleterious effects that cold storage has on DCD kidneys. This includes normothermic perfusion of organs in situ, deemed normothermic regional perfusion (NRP), and ex vivo perfusion after procurement of the organ, referred to as normothermic machine perfusion (NMP) NMP has proved useful in kidneys that would otherwise be discarded but also as a platform for assessment and reconditioning of marginal organs …”