Renal Perfusion Pump Vs Cold Storage for Donation After Cardiac Death Kidneys: A Systematic Review

Bathini, Varunkumar; McGregor, Thomas; McAlister, Vivian C.; Luke, Patrick; Şener, Alp

doi:10.1016/j.juro.2012.11.173

Cited by 53 publications

(53 citation statements)

References 17 publications

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“…The long-term survival of transplanted kidneys has continued to improve over time attributable to improved immunosuppressant regimens and advancements in organ storage technology. 1,2 Despite the success of renal transplantation, postoperative complications can be expected and are not categorically benign. Patients with ESRD often possess multiple co-morbidities including anemia, diabetes, peripheral vascular disease and cardiovascular disease.…”

Section: Introductionmentioning

confidence: 99%

Complications in the 90-day postoperative period following kidney transplant and the relationship of the Charlson Comorbidity Index

Levine

Schuler

Gourishankar

2017

CUAJ

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Introduction: Renal transplant experiences widespread success, but little is published regarding the postoperative complications. The Charlson Comorbidity Index (CCI) is a system of mortality risk assessment. Our purpose is to assess the 90-day postoperative complications after renal transplantation. The secondary objective is to clarify whether CCI predicts complications. We hypothesized increased CCI corresponds to worse complication on the Clavien scale. Methods: This is a retrospective analysis of renal recipients at our institution (2011)(2012)(2013), who were ≥18 years old and received complete follow up. CCI, age, gender, body mass index (BMI), and graft type were extracted from the electronic medical records. Complications were scored using the Clavien scale. Descriptive statistics and logistic regression were used to analyze 198 patients. Results: The mean age was 53 (standard deviation [SD] 14), mean BMI 27.4 (SD 14), median CCI 1. Grade 2 or higher (significant) complications occurred in 60% of patients and Grade 3b or higher (severe) in 15% of patients in the 90-day postoperative period. Sixty-eight different complications were identified, the most common being blood transfusion (19%). Logistic regression suggests a predictive value of CCI (odds ratio [OR] 1.70; 95% confidence interval [CI] 1.3-2.3) for severe complications, with DM and PVD conferring increased risk. Conclusions: Renal transplant carries significant risk. This data can be used to improve patient counselling on the likely postoperative course. Study limitations include the retrospective design, predisposing to potential bias in data capture.

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Section: Introductionmentioning

confidence: 99%

Complications in the 90-day postoperative period following kidney transplant and the relationship of the Charlson Comorbidity Index

Levine

Schuler

Gourishankar

2017

CUAJ

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“…Abbreviations: Akt, protein kinase B; AMPKa, 5 0 -adenosine monophosphate-activated protein kinase alpha; ANOVA, analysis of variance; CS, cold storage; CTL, control; DCD, donation after circulatory death; eNOS, endothelial nitric oxide synthase; GAPDH, glyceraldehyde-3-phosphate dehydrogenase; iNOS, inducible nitric oxide synthase; KLF2, Kruppel-like factor 2; L19, ribosomal protein L19; L-NAME, NGnitro-L-arginine methyl ester; MP, machine perfusion; MPS, machine perfusion solution; NO, nitric oxide;Introduction Nonoxygenated hypothermic machine perfusion (MP) of kidneys donated after circulatory death (DCD) reduces delayed graft function incidence compared to static cold storage (CS) (1)(2)(3)(4). In expanded criteria donors, MP increases graft survival as well (1)(2)(3)(4).…”

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confidence: 99%

“…In expanded criteria donors, MP increases graft survival as well (1)(2)(3)(4). However, the mechanism of this protection remains unclear, which slows down improvements of this technology.…”

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confidence: 99%

Mechanistic Analysis of Nonoxygenated Hypothermic Machine Perfusion’s Protection on Warm Ischemic Kidney Uncovers Greater eNOS Phosphorylation and Vasodilation

Chatauret

Coudroy

Delpech

et al. 2014

American Journal of Transplantation

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Protection of endothelial cell function may explain the benefits of nonoxygenated hypothermic machine perfusion (MP) for marginal kidney preservation. However, this hypothesis remains to be tested with a preclinical model. We postulated that MP protects the nitric oxide (NO) signaling pathway, altered by static cold storage (CS), and improves renal circulation recovery compared to CS. The endothelium releases the vasodilator NO in response to flow via either increased endothelial NO synthase (eNOS) expression (KLF2-dependent) or activation of eNOS by phosphorylation (via Akt, PKA or AMPK). Using a porcine model of kidney transplantation, including 1 h of warm ischemia and preserved 24 h by CS or MP (n ¼ 5), we reported that MP did not alter the cortical levels of KLF2 and eNOS at the end of preservation, but significantly increased eNOS activating phosphorylation compared to CS. eNOS phosphorylation appeared AMPK-dependent and was concomitant to an increased NO-dependent vasodilation of renal arteries measured, ex situ, at the end of preservation. In vivo, laser Doppler showed that cortical microcirculation was improved at reperfusion in MP kidneys. In conclusion, we demonstrate for the first time, in a large-animal model, that MP protects the NO signaling pathway, confirming the value of MP for marginal kidney preservation.Abbreviations: Akt, protein kinase B; AMPKa, 5 0 -adenosine monophosphate-activated protein kinase alpha; ANOVA, analysis of variance; CS, cold storage; CTL, control; DCD, donation after circulatory death; eNOS, endothelial nitric oxide synthase; GAPDH, glyceraldehyde-3-phosphate dehydrogenase; iNOS, inducible nitric oxide synthase; KLF2, Kruppel-like factor 2; L19, ribosomal protein L19; L-NAME, NGnitro-L-arginine methyl ester; MP, machine perfusion; MPS, machine perfusion solution; NO, nitric oxide; PKA, protein kinase A; RPLPO, ribosomal phosphoprotein large P0 subunit; RT-qPCR, reverse transcriptase quantitative polymerase chain reaction; SEM, standard error of the mean; UW, University of Wisconsin; WI-60, 1 h warm ischemia

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“…27,28 Interventions aimed at reducing delayed graft function, such as systemic hypothermia in donors, pulsatile machine perfusion and adjustment of immunosuppressive regimens in recipients, may be particularly important when kidneys are procured from donors whose organs are at high risk for delayed graft function, such as those with prolonged cardiac arrest. [28][29][30] Authors of previous small studies have assessed organ injury in brain-dead donors who experienced cardiac arrest. [31][32][33][34] Those with anoxic brain injury were generally reported to have greater hemodynamic instability and higher liver enzymes, and fewer organs were procured from these donors.…”

Section: Discussionmentioning

confidence: 99%

Time trends in organ donation after neurologic determination of death: a cohort study

2017

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Background:The cause of brain injury may influence the number of organs that can be procured and transplanted with donation following neurologic determination of death. We investigated whether the distribution of causes responsible for neurologic death has changed over time and, if so, whether this has had an impact on organ quality, transplantation rates and recipient outcomes. Methods:We performed a cohort study involving consecutive brain-dead organ donors in southern Alberta between 2003 and 2014. For each donor, we determined last available measures of organ injury and number of organs transplanted, and compared these variables for various causes of neurologic death. We compared trends to national Canadian data for 2000-2013 (2000-2011 for Quebec).Results: There were 226 brain-dead organ donors over the study period, of whom 100 (44.2%) had anoxic brain injury, 63 (27.9%) had stroke, and 51 (22.6%) had traumatic brain injury. The relative proportion of donors with traumatic brain injury decreased over time (> 30% in 2003-2005 v. 6%-23% in 2012-2014) (p = 0.004), whereas that with anoxic brain injury increased (14%-37% v. 46%-80%, respectively) (p < 0.001). Nationally, the annual number of brain-dead donors with traumatic brain injury decreased from 4.4 to less than 3 per million population between 2000 and 2013, and that with anoxic brain injury increased from 1.1 to 3.1 per million. Donors with anoxic brain injury had higher concentrations of creatinine, alanine aminotransferase and troponin T, and lower P a O 2 /F I O 2 and urine output than donors with other diagnoses. The average number of organs transplanted per donor was 3.6 with anoxic brain injury versus 4.5 with traumatic brain injury or stroke (p = 0.002).Interpretation: Anoxic brain injury has become a leading cause of organ donation after neurologic determination of death in Canada. Organs from donors with anoxic brain injury have a greater degree of injury, and fewer are transplanted. These findings have implications for availability of organs for transplantation in patients with end-stage organ failure. AbstractResearch Research CMAJ OPEN E20CMAJ OPEN, 5(1)We performed a cohort study among consecutive braindead donors in southern Alberta to determine whether the distribution of causes responsible for neurologic death has changed (primary outcome) and, if so, whether this has had an impact on organ quality, transplantation rates and recipient outcomes (secondary outcomes). Using data from the Canadian Institute of Health Information (CIHI), we also assessed trends in the cause of neurologic death and number of organs transplanted per donor across Canada. Methods SettingA comprehensive clinical information system (ALTRABase) is used to manage all organ donation referrals in southern Alberta and enables linkage of donor and recipient data. Donor management is in accordance with national guidelines, which are incorporated directly into a region-wide electronic order set. 18 In every case, solid organs are routinely offered to transplantation ...

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Renal Perfusion Pump Vs Cold Storage for Donation After Cardiac Death Kidneys: A Systematic Review

Cited by 53 publications

References 17 publications

Complications in the 90-day postoperative period following kidney transplant and the relationship of the Charlson Comorbidity Index

Complications in the 90-day postoperative period following kidney transplant and the relationship of the Charlson Comorbidity Index

Mechanistic Analysis of Nonoxygenated Hypothermic Machine Perfusion’s Protection on Warm Ischemic Kidney Uncovers Greater eNOS Phosphorylation and Vasodilation

Time trends in organ donation after neurologic determination of death: a cohort study

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