Successful Transplantation of Human Kidneys Deemed Untransplantable but Resuscitated by Ex Vivo Normothermic Machine Perfusion

Abstract

We report the successful transplantation of a pair of human kidneys that were declined for transplantation due to inadequate in situ perfusion but subsequently transplanted after perfusion and assessment using ex vivo normothermic perfusion (EVNP). The kidneys were from a 35‐year‐old man, a donation after circulatory death donor. Both kidneys were declined by all UK transplant centers. On arrival, the kidneys had significant areas of incomplete clearance of blood from the microcirculation that did not clear after a further attempt to flush them. Kidneys underwent 60 min of EVNP with an oxygenated packed red blood cell–based solution warmed to 35.2°C. During EVNP, the patchy areas cleared in both kidneys. The mean renal blood flow and total urine output were 68.0 mL/min/100 g and 560 mL in the left kidney and 59.9 mL/min/100 g, 430 mL in the right, respectively. Based on the EVNP perfusion parameters, both kidneys were deemed suitable for transplantation. They were transplanted without any complications, and both recipients had initial graft function. The serum creatinine levels at 3 months were 1.2 mg/dl in the recipient of the left kidney and 1.62 mg/dl in the recipient of the right kidney. EVNP technology can be used to assess and rescue kidneys previously deemed unsuitable for transplantation.

The effect on early renal function of various dynamic preservation strategies in a preclinical pig ischemia–reperfusion autotransplant model

“…19,31 Underlying mechanisms of NP are not fully understood. 19,31 Underlying mechanisms of NP are not fully understood.…”

Synthetic hemoglobin-based oxygen carriers are an acceptable alternative for packed red blood cells in normothermic kidney perfusion

“…[13][14][15][16][17] Published reports of NEVKP to date have relied exclusively on the human red blood cell-based perfusates, whether in the form of whole blood, leukocyte-depleted blood, or packed red blood cells (PRBC), as the oxygen carrier of the system, in an attempt to recapitulate the optimal physiologic environment. [13][14][15][16][17] Published reports of NEVKP to date have relied exclusively on the human red blood cell-based perfusates, whether in the form of whole blood, leukocyte-depleted blood, or packed red blood cells (PRBC), as the oxygen carrier of the system, in an attempt to recapitulate the optimal physiologic environment.…”

Development of an objective, standardized tool for surgical assessment of deceased donor kidneys: The Cambridge Kidney Assessment Tool

“…However, it would be erroneous to assume that this increased sensitivity necessarily implies a better test, as that would depend on the outcomes of the kidneys had they been transplanted. Although this cannot be proved definitively in the absence of functional outcome measures in transplanted patients, further tests of “transplantability”—like ex vivo perfusion or pre‐implantation biopsy—could be used in combination for kidneys deemed at higher risk of decline following macroscopic assessment, although this would depend on local availability and the outcomes of ongoing trials …”