Pulsatile Perfusion Preservation for Expanded-Criteria Donors Kidneys: Impact on Delayed Graft Function Rate

Abboud, Imad; Gaudez, F.; Fieux, Fabienne; Lefaucheur, Carmen; Pillebout, Évangéline; Viglietti, Denis; Serrato, Tomas; Verine, Jérôme; Flamant, Martin; Péraldi, Marie-Noëlle; Glotz, Denis

doi:10.5301/ijao.2011.8458

Cited by 18 publications

(49 citation statements)

References 20 publications

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“…Based on the search strategies and selection criteria, we included seven studies comparing HMP to CS in this review [5], [17]–[22], involving 2374 and 8716 kidney grafts with HMP and CS preservation respectively, all from ECD donors. Of these seven studies, two were randomized controlled trials(RCTs), one was a prospective study, and four were retrospective studies.…”

Section: Resultsmentioning

confidence: 99%

“…Five studies reported the incidence of PNF after transplantation[5], [17], [18], [20], [21]. One study defined PNF as a permanent lack of function of the allograft from the time of transplantation[5].…”

Section: Resultsmentioning

confidence: 99%

“…One study defined PNF as a permanent lack of function of the allograft from the time of transplantation[5]. The other four studies did not provide a definition of PNF.…”

Section: Resultsmentioning

confidence: 99%

“…Because of a persistent donor organ shortage, kidneys from expanded criteria donors (ECDs) are currently accepted by many centers and have been successfully transplanted to increase the donor pool [2], [3], thereby facilitating timely kidney transplantation for elderly recipients who would not survive long waiting periods [4], [5] ECDs are defined as allografts from deceased donors older than 60 years of age and those from donors aged 50–59 years old with at least two of the followings characteristics: history of hypertension, serum creatinine greater than 1.5 mg/dL or cerebrovascular as the cause of death[6]. Compared with standard criteria donor(SCD) kidneys, kidneys from ECDs can be associated with a higher rate of delayed graft function(DGF), primary non-function(PNF),acute rejection and a more complicated postoperative course, resulting in inferior long-term graft survival overall [7]–[10].…”

Section: Introductionmentioning

confidence: 99%

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Hypothermic Machine Perfusion Reduces Delayed Graft Function and Improves One-Year Graft Survival of Kidneys from Expanded Criteria Donors: A Meta-Analysis

et al. 2013

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BackgroundExpanded criteria donors (ECDs) are currently accepted as potential sources to increase the donor pool and to provide more chances of kidney transplantation for elderly recipients who would not survive long waiting periods. Hypothermic machine perfusion (HMP) is designed to mitigate the deleterious effects of simple cold storage (CS) on the quality of preserved organs, particularly when the donor is in a marginal status.MethodsWe compared the transplant outcomes in patients receiving ECD kidneys with either HMP or CS graft preservation. Articles from the MEDLINE, EMBASE and Cochrane Library databases were searched and all studies reporting outcomes from HMP versus CS methods of kidney preservation were included in this meta-analysis. The parameters analyzed included the incidence of delayed graft function (DGF), primary non-function (PNF) and one-year graft and patient survival.ResultsA total of seven studies qualified for the review, involving 2374 and 8716 kidney grafts with HMP or CS preservation respectively, all from ECD donors. The incidence of delayed graft function (DGF) was significantly reduced with an odd ratio(OR) of 0.59 (95% CI 0.54–0.66, P<0.001) and one-year graft survival was significantly improved with an OR of 1.12 (95% CI 1.03–1.21, P = 0.005) in HMP preservation compared to CS. However, there was no difference in the incidence of PNF (OR 0.54, 95% CI 0.21–1.40, P = 0.20), and one-year patient survival (OR 0.98, 95% CI 0.94–1.02, P = 0.36) between HMP and CS preservation.ConclusionsHMP was associated with a reduced incidence of DGF and an with increased one-year graft survival, but it was not associated with the incidence of PNF and one-year patient survival.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…One study defined PNF as a permanent lack of function of the allograft from the time of transplantation[5]. The other four studies did not provide a definition of PNF.…”

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hypothermic Machine Perfusion Reduces Delayed Graft Function and Improves One-Year Graft Survival of Kidneys from Expanded Criteria Donors: A Meta-Analysis

et al. 2013

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“…While the effects of 30–90 minutes of warm renal ischemia per se produce measured reperfusion injury to the kidney at transplantation, the addition of inevitable periods of hypothermia from traditional organ preservation, no matter how brief, produces potentiating injury that exceeds the sum of both factors combined [4, 5]. This typically results in very high incidence of delayed graft function (DGF) following transplantation [6]. …”

Section: Introductionmentioning

confidence: 99%

Hypothermic Machine Perfusion Preservation of the DCD Kidney: Machine Effects

Lindell

Muir

Brassil³

et al. 2013

Journal of Transplantation

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Purpose. Kidneys from DCD donors represent a significant pool, but preservation problems exist. The study objective was to test the importance of machine type for hypothermic preservation of DCD kidneys. Methods. Adult Beagle dog kidneys underwent 45 minutes of warm in situ ischemia followed by hypothermic perfusion for 24 hours (Belzer-MPS Solution) on either an ORS LifePort or a Waters RM3 using standard perfusion protocols. Kidneys were then autotransplanted, and renal function was assessed over 7 days following contralateral nephrectomy. Results. Renal vascular resistance was not different between the two pumps. After 24 hours, the oxygen partial pressure and oxygen delivery in the LifePort perfusate were significantly lower than those in the RM3 but not low enough to change lactate production. TheLifePort ran significantly colder than RM3 (2° versus 5°C). The arterial pressure waveform of the RM3 was qualitatively different from the waveform of the LifePort. Preservation injury after transplantation was not different between the devices. When the LifePort was changed to nonpulsatile flow, kidneys displayed significantly greater preservation injury compared to RM3. Conclusions. Both LifePort and RM3 can be used for hypothermic machine perfusion preservation of DCD kidneys with equal outcomes as long as the duty cycle remains pulsatile.

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Systematic review and meta-analysis of hypothermic machine perfusion versus static cold storage of kidney allografts on transplant outcomes

O’Callaghan

Morgan

Knight

et al. 2013

British Journal of Surgery

136

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Pulsatile Perfusion Preservation for Expanded-Criteria Donors Kidneys: Impact on Delayed Graft Function Rate

Abstract: Pulsatile perfusion preservation significantly reduced DGF rate in ECD kidney transplantation.

Cited by 18 publications

References 20 publications

Hypothermic Machine Perfusion Reduces Delayed Graft Function and Improves One-Year Graft Survival of Kidneys from Expanded Criteria Donors: A Meta-Analysis

Hypothermic Machine Perfusion Reduces Delayed Graft Function and Improves One-Year Graft Survival of Kidneys from Expanded Criteria Donors: A Meta-Analysis

Hypothermic Machine Perfusion Preservation of the DCD Kidney: Machine Effects

Systematic review and meta-analysis of hypothermic machine perfusion versus static cold storage of kidney allografts on transplant outcomes

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