Supplemental oxygen during hypothermic kidney preservation: A systematic review

Abstract

We reviewed the evidence for ex-vivo Supplemental Oxygen during Hypothermic preservation (SOH) for deceased donor kidneys. Bibliographic databases were searched for human and animal studies of SOH in kidney transplantation reporting on patient or animal survival rate, discard rate, technical complications or renal function outcomes. We make special reference to a specific subgroup: supplemental oxygen applied during cold perfusion, referred to as Hypothermic Oxygenated Perfusion (HOP). Four human and 25 animal studies were identified. The data present conflicting results but suggest that the effects of oxygen on restoring kidney function during preservation may be of value for DCD kidneys and/or kidneys that have undergone a period of hypotension, warm ischemia or poor perfusion in the donor. There is very little information available from human or animal studies. This work highlights to the transplant community that far more high quality clinical studies are required to understand this technology and its role before widespread clinical introduction.

Oxygenated versus standard cold perfusion preservation in kidney transplantation (COMPARE): a randomised, double-blind, paired, phase 3 trial

“…[5][6][7][8][9][10] To date, there are no well-designed clinical studies assessing the effect of HMPO2 in kidney transplantation. 11 This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process. perfusion settings were made and all involved were blinded to perfusion characteristics.…”

Individual and Combined Impact of Oxygen and Oxygen Transporter Supplementation during Kidney Machine Preservation in a Porcine Preclinical Kidney Transplantation Model

“…Previous studies showed benefits of perfusion with 100% O 2 versus none, but these studies were performed in different experimental conditions [3,8,28]. Expected results of two ongoing clinical trials from the Consortium for Organ Preservation in Europe (COPE), the first of which compares HMP + O 2 between HMP in DCD kidneys (COMPARE Trial, ISRCTN32967929), and the second in ECD kidneys compares end-ischemic HMP + O 2 or none (POMP Trial, ISRCTN63852508) will undoubtedly bring useful information [29,30].…”

Barriers and Advances in Kidney Preservation

“…However, experimental evidence tends to show a majorly beneficial use of oxygenation. In the current context of unavoidable donor pools expansion, oxygen supplementation during hypothermic preservation is the focus of numerous preclinical and clinical studies, including nonheart-beating, heart-beating, and higher-risk donors [17–19]. Naturally called for, the use of oxygen in normothermic preservation is considered elsewhere [2, 18, 20].…”