Novel preservation methods to increase the quality of older kidneys

Brat, Aukje; Pol, Robert A.; Leuvenink, Henri G. D.

doi:10.1097/mot.0000000000000215

Cited by 18 publications

(18 citation statements)

References 49 publications

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“…4 In addition, convincing data are lacking, addressing underlying mechanisms of kidney graft protection by machine perfusion. 7 On the basis of this, the overall acceptance of perfusion systems for kidneys has remained relatively poor in many centers, despite the fact that the rate of delayed graft function (DGF) undoubtedly improved by machine kidney perfusion, especially in ECD grafts. 23 Recent studies, however, have triggered a clinical reinterest in kidney machine perfusion, mainly in UK.…”

Section: Discussionmentioning

confidence: 99%

“…8,32 On the basis of these observations, the current clinical practice of DCD kidney perfusion may need to be adapted, being most frequently continuous cold perfusion using a pressure of (30/20 mm Hg) LifePort Kidney Transporter (Organ Recovery Systems, Chicago, IL) without active oxygenation. 4,7,31 Notably, the difference between both perfusion techniques appears multifactorial because of several varying parameters, for example, perfusate composition, temperature, pO 2 , and perfusion pressure. The results of this study therefore need to be confirmed in human by randomized trials.…”

Section: Discussionmentioning

confidence: 99%

“…3 Therefore, new concepts of preservation, for example, machine perfusion instead of conventional cold static storage, have been suggested to improve graft viability, differing mainly in perfusate conditions, including temperature and timing of perfusion. [4][5][6][7] In this context, our group developed a short-term 1 to 2-hour Hypothermic Oxygenated Perfusion (HOPE), applied after cold storage in liver transplantation. [8][9][10][11][12][13] In various animal transplant models, we showed a high protective effect of HOPE.…”

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confidence: 99%

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Short, Cool, and Well Oxygenated – HOPE for Kidney Transplantation in a Rodent Model

et al. 2016

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Short, Cool, and Well Oxygenated – HOPE for Kidney Transplantation in a Rodent Model

et al. 2016

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“…Ex vivo normothermic perfusion of grafts from ECDs offers an interesting new approach . Standard cold anoxic storage is associated with ongoing graft injury and prohibits graft assessment.…”

Section: Donor Graft Preservationmentioning

confidence: 99%

Prediction, prevention, and management of delayed graft function: where are we now?

Nashan

Abbud-Filho

Citterio

2016

Clinical Transplantation

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Delayed graft function (DGF) remains a major barrier to improved outcomes after kidney transplantation. High-risk transplant recipients can be identified, but no definitive prediction model exists. Novel biomarkers to predict DGF in the first hours post-transplant, such as neutrophil gelatinase-associated lipocalin (NGAL), are under investigation. Donor management to minimize the profound physiological consequences of brain death is highly complex. A hormonal resuscitation package to manage the catecholamine "storm" that follows brain death is recommended. Donor pretreatment with dopamine prior to procurement lowers the rate of DGF. Hypothermic machine perfusion may offer a significant reduction in the rate of DGF vs simple cold storage, but costs need to be evaluated. Surgically, reducing warm ischemia time may be advantageous. Research into recipient preconditioning options has so far not generated clinically helpful interventions. Diagnostic criteria for DGF vary, but requirement for dialysis and/or persistent high serum creatinine is likely to remain key to diagnosis until current work on early biomarkers has progressed further. Management centers on close monitoring of graft (non)function and physiological parameters. With so many unanswered questions, substantial reductions in the toll of DGF in the near future seem unlikely but concentrated research on many levels offers long-term promise.

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“…However, these organs show a higher risk for unfavorable outcome as they are more susceptible to ischemia reperfusion injury (IRI) (2, 3). In the need to improve organ viability and function, most notably machine perfusion has been proven to exert beneficial effects on organ preservation in a number of experimental and clinical trials (4–7).…”

Section: Introductionmentioning

confidence: 99%

Graft Pre-conditioning by Peri-Operative Perfusion of Kidney Allografts With Rabbit Anti-human T-lymphocyte Globulin Results in Improved Kidney Graft Function in the Early Post-transplantation Period—a Prospective, Randomized Placebo-Controlled Trial

et al. 2018

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Introduction: Although prone to a higher degree of ischemia reperfusion injury (IRI), the use of extended criteria donor (ECD) organs has become reality in transplantation. We therefore postulated that peri-operative perfusion of renal transplants with anti-human T-lymphocyte globulin (ATLG) ameliorates IRI and results in improved graft function.Methods: We performed a randomized, single-blinded, placebo-controlled trial involving 50 kidneys (KTx). Prior to implantation organs were perfused and incubated with ATLG (AP) (n = 24 kidney). Control organs (CP) were perfused with saline only (n = 26 kidney). Primary endpoint was defined as graft function reflected by serum creatinine at day 7 post transplantation (post-tx).Results: AP-KTx recipients illustrated significantly better graft function at day 7 post-tx as reflected by lower creatinine levels, whereas no treatment effect was observed after 12 months surveillance. During the early hospitalization phase, 16 of the 26 CP-KTx patients required dialysis during the first 7 days post-tx, whereas only 10 of the 24 AP-KTx patients underwent dialysis. No treatment-specific differences were detected for various lymphocytes subsets in the peripheral blood of patients. Additionally, mRNA analysis of 0-h biopsies post incubation with ATLG revealed no changes of intragraft inflammatory expression patterns between AP and CP organs.Conclusion: We here present the first clinical study on peri-operative organ perfusion with ATLG illustrating improved graft function in the early period post kidney transplantation.Clinical Trial Registration: www.ClinicalTrials.gov, NCT03377283

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Novel preservation methods to increase the quality of older kidneys

Cited by 18 publications

References 49 publications

Short, Cool, and Well Oxygenated – HOPE for Kidney Transplantation in a Rodent Model

Short, Cool, and Well Oxygenated – HOPE for Kidney Transplantation in a Rodent Model

Prediction, prevention, and management of delayed graft function: where are we now?

Graft Pre-conditioning by Peri-Operative Perfusion of Kidney Allografts With Rabbit Anti-human T-lymphocyte Globulin Results in Improved Kidney Graft Function in the Early Post-transplantation Period—a Prospective, Randomized Placebo-Controlled Trial

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