Transplantation of kidneys from uncontrolled donation after circulatory determination of death: comparison with brain death donors with or without extended criteria and impact of normothermic regional perfusion

Demiselle, Julien; Augusto, Jean-François; Videcoq, M.; Legeard, E.; Dubé, Laurent; Templier, F.; Renaudin, Karine; Sayegh, Johnny; Karam, Georges; Blancho, Gilles; Dantal, Jacques

doi:10.1111/tri.12722

Cited by 62 publications

(75 citation statements)

References 37 publications

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“…In a prospective study by Demiselle et al . , NRP in uncontrolled DCD donation led to a lower DGF rate and a better renal graft function 2 years after transplantation compared with cold stored DCD kidneys and extended criteria DBD kidneys.…”

Section: Perfusion and Re‐conditioning Methods For Abdominal Organsmentioning

confidence: 93%

The future of organ perfusion and re‐conditioning

et al. 2019

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Summary Organ preservation and re‐conditioning using machine perfusion technologies continue to generate promising results in terms of viability assessment, organ utilization and improved initial graft function. Here, we summarize the latest findings and study the results of ex‐vivo/ex‐situ hypothermic (HMP) and normothermic machine perfusion (NMP) in the area of abdominal organ transplantation (kidney, liver, pancreas and intestine). We also consider the potential role of normothermic regional perfusion (NRP) to re‐condition donors after circulatory death organs before retrieval. The findings from clinical studies reported to date suggest that machine perfusion will offer real benefits when compared with conventional cold preservation. Several randomized trials are expected to report their findings within the next 2 years which may shed light on the relative merits of different perfusion methods and could indicate which perfusion parameters may be most useful to predict organ quality and viability. Further work is needed to identify composite endpoints that are relevant for transplanted organs that have undergone machine preservation. Multi‐centre trials to compare and analyse the combinations of NRP followed by HMP and/or NMP, either directly after organ retrieval using transportable devices or when back‐to‐base, are needed. The potential applications of machine preservation technology beyond the field of solid organ transplantation are also considered.

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Section: Perfusion and Re‐conditioning Methods For Abdominal Organsmentioning

confidence: 93%

The future of organ perfusion and re‐conditioning

et al. 2019

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“…Kidneys from uDCD can be a useful source of grafts when selecting criteria, advanced resuscitation and preservation procedures are used . In the present study, we used the selecting criteria and resuscitation procedures recommended by the French Agency of Biomedicine, which is the French national regulatory authority for organ and tissue procurement and transplantation.…”

Section: Discussionmentioning

confidence: 99%

Hypothermic pulsatile preservation of kidneys from uncontrolled deceased donors after cardiac arrest - a retrospective study

et al. 2017

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Kidneys from uncontrolled donors after cardiac arrest (uDCD) suffer from a period of warm ischemia between cardiac arrest and cold flushing. Aim of the study was to evaluate renal outcomes of uDCD kidneys selected on the basis of renal Resistance Index (RI) and its influence on graft function and survival. The study included 44 kidneys procured from 26 uDCD starting 1.1.2006 until 12.31.2013. The donors (Maastricht category II) underwent cardiopulmonary resuscitation by assisted ventilation and chest compression; the organs were preserved with in situ cold perfusion or a normothermic regional perfusion. All kidneys were perfused on hypothermic (1-4 °C) pulsatile perfusion machine (RM3; Waters Medical System) and discarded when RI ≥0.5 mmHg/ml/min after 6 h of perfusion. There was one (2.2%) primary non function, while 37 recipients (84.1%) experienced delayed graft function. Graft survival was 97.6% at 1 and 3 post-transplantation years. Linear regression models showed that lower values of RI at the end of perfusion were associated with higher values of Modification of Diet in Renal Disease at 3 (P = 0.049) and 6 months after transplantation (P = 0.010) and with higher values of inulin clearance at 1 year (P = 0.030). RI showed to be a useful tool to select uDCD kidneys allowing to achieve good clinical results.

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“…[1][2][3][4] These organs are more prone to ischemia-reperfusion injuries (IRIs), which have a negative impact on outcome. [7][8][9][10][11][12][13] NRP is beneficial for organ reconditioning, 4,7,[14][15][16] in terms of donor pool expansion and graft function, [17][18][19][20][21] and superior to cold in situ cooling 7 and hypothermic cardiopulmonary bypass. 5,6 Hence, these organs must be reconditioned.…”

Section: Introductionmentioning

confidence: 99%

Defining the optimal duration for normothermic regional perfusion in the kidney donor: A porcine preclinical study

Kerforne

Allain

Giraud

et al. 2019

American Journal of Transplantation

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Kidneys from donation after circulatory death (DCD) are highly sensitive to ischemia-reperfusion injury and thus require careful reconditioning, such as normothermic regional perfusion (NRP). However, the optimal NRP protocol remains to be characterized. NRP was modeled in a DCD porcine model (30 minutes of cardiac arrest) for 2, 4, or 6 hours compared to a control group (No-NRP); kidneys were machine-preserved and allotransplanted. NRP appeared to permit recovery from warm ischemia, possibly due to an increased expression of HIF1α-dependent survival pathway. At 2 hours, blood levels of ischemic injury biomarkers increased: creatinine, lactate/pyruvate ratio, LDH, AST, NGAL, KIM-1, CD40 ligand, and soluble-tissue-factor. All these markers then decreased with time; however, AST, NGAL, and KIM-1 increased again at 6 hours. Hemoglobin and platelets decreased at 6 hours, after which the procedure became difficult to maintain. Regarding inflammation, active tissue-factor, cleaved PAR-2 and MCP-1 increased by 4-6 hours, but not TNF-α and iNOS. Compared to No-NRP, NRP kidneys showed lower resistance during hypothermic machine perfusion (HMP), likely associated with pe-NRP eNOS activation. Kidneys transplanted after 4 and 6 hours of NRP showed better function and outcome, compared to No-NRP. In conclusion, our results confirm the mechanistic benefits of NRP and highlight 4 hours as its optimal duration, after which injury markers appear.

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Transplantation of kidneys from uncontrolled donation after circulatory determination of death: comparison with brain death donors with or without extended criteria and impact of normothermic regional perfusion

Cited by 62 publications

References 37 publications

The future of organ perfusion and re‐conditioning

The future of organ perfusion and re‐conditioning

Hypothermic pulsatile preservation of kidneys from uncontrolled deceased donors after cardiac arrest - a retrospective study

Defining the optimal duration for normothermic regional perfusion in the kidney donor: A porcine preclinical study

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