Use of ex vivo normothermic machine perfusion after normothermic regional perfusion to salvage a poorly perfused DCD kidney

Georgiades, Fanourios; Hosgood, Sarah A.; Butler, Andrew; Nicholson, Michael L.

doi:10.1111/ajt.15547

Cited by 14 publications

(12 citation statements)

References 21 publications

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“…In each of the cases, NMP was used to salvage the kidneys after they were inadequately flushed during retrieval. 127 , 128 In 1 case, the kidney was retrieved after NRP. In both cases, the kidneys performed well during NMP and were transplanted successfully.…”

Section: Kidney Preservation Techniquesmentioning

confidence: 99%

Advances in Kidney Preservation Techniques and Their Application in Clinical Practice

Hosgood

Brown²,

Nicholson³

2021

Transplantation

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The use of cold preservation solutions to rapidly flush and cool the kidney followed by static cold storage in ice has been the standard kidney preservation technique for the last 50 y. Nonetheless, changing donor demographics that include organs from extended criteria donors and donation after circulatory death donors have led to the adoption of more diverse techniques of preservation. Comparison of hypothermic machine perfusion and static cold storage techniques for deceased donor kidneys has long been debated and is still contested by some. The recent modification of hypothermic machine perfusion techniques with the addition of oxygen or perfusion at subnormothermic or near-normothermic temperatures are promising strategies that are emerging in clinical practice. In addition, the use of normothermic regional perfusion to resuscitate abdominal organs of donation after circulatory death donors in situ before cold flushing is also increasingly being utilized. This review provides a synopsis of the different types of preservation techniques including their mechanistic effects and the outcome of their application in clinical practice for different types of donor kidney.

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Section: Kidney Preservation Techniquesmentioning

confidence: 99%

Advances in Kidney Preservation Techniques and Their Application in Clinical Practice

Hosgood

Brown²,

Nicholson³

2021

Transplantation

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“…In addition, several groups are exploring the use of normothermic machine perfusion to evaluate and optimize kidneys pre‐implantation 25 . Kidneys with sub‐optimal perfusion have been successfully evaluated and transplanted after a period of machine perfusion 17,26 . Our data may help identify kidneys that could benefit from such “rescue therapy.” This would particularly be valuable for grade 2–4 kidneys, where there is doubt regarding their viability.…”

Section: Discussionmentioning

confidence: 99%

Macroscopic assessment of the quality of cold perfusion after deceased‐donor kidney procurement: A United Kingdom population‐based cohort study

Dabare

Hodson

Nath

et al. 2021

Clinical Transplantation

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Concern regarding the quality of cold perfusion (QOP) during macroscopic assessment of procured kidneys is a common reason for discard. In the UK, QOP is routinely graded by both retrieving and implanting teams during back‐bench surgery as: 1 (good), 2 (fair), 3 (poor) or 4 (patchy). We evaluated the association of this grading with organ utilization, graft outcomes, and agreement between teams. Data on all deceased‐donor kidneys procured between January 2000 and December 2016 were analyzed for discard rates, while association with graft outcomes was studied in single adult transplants. Of 31,167 kidneys procured, 90.6%, 5.7%, 1.7%, and 2.1% were assigned grades 1, 2, 3, and 4, respectively, at retrieval. QOP was an independent risk factor of discard, with the highest rates observed in grade 3 kidneys (41.8%), compared to 6.5% in grade 1 (aOR 7.67, 95% CI 5.44–10.82, p < .001). Grading at retrieval was an independent predictor of delayed graft function (p = .019) and primary non‐function (p = .001), but not long‐term graft survival (p = .111). Implanting grade was an independent predictor of all three outcomes (p < .001, p < .001, and p = .002, respectively). Consistency of grading between teams was poor (Kappa = 0.179). QOP influences utilization and predicts outcomes, but a standardized and validated scoring system is required.

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“…Furthermore, our group reported that the use of ex vivo NMP after normothermic regional perfusion improved a poorly perfused DCD kidney that was then transplanted into a suitable recipient. The recipient had slow early graft function, but did not require dialysis posttransplant, and was discharged six days later with an SCr of 160 μmol/L (1.8 mg/dL) at two months posttransplant [ 36 ]. Therefore, discarded DCD donor kidneys, at least some of them, could be salvaged by NMP.…”

Section: Discussionmentioning

confidence: 99%

Comparative Analysis of Risk Factors in Declined Kidneys from Donation after Brain Death and Circulatory Death

et al. 2020

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Background and objectives: Kidneys from donation after circulatory death (DCD) are more likely to be declined for transplantation compared with kidneys from donation after brain death (DBD). The aim of this study was to evaluate characteristics in the biopsies of human DCD and DBD kidneys that were declined for transplantation in order to rescue more DCD kidneys. Materials and Methods: Sixty kidney donors (DCD = 36, DBD = 24) were recruited into the study and assessed using donor demographics. Kidney biopsies taken post cold storage were also evaluated for histological damage, inflammation (myeloperoxidase, MPO), von Willebrand factor (vWF) expression, complement 4d (C4d) deposition and complement 3 (C3) activation using H&E and immunohistochemistry staining, and Western blotting. Results: More DBD donors (16/24) had a history of hypertension compared with DCDs (8/36, p = 0.001). The mean warm ischemic time in the DCD kidneys was 12.9 ± 3.9 min. The mean cold ischemic time was not significantly different between the two groups of kidney donors (DBD 33.3 ± 16.7 vs. DCD 28.6 ± 14.1 h, p > 0.05). The score of histological damage and MPO, as well as the reactivity of vWF, C4d and C3, varied between kidneys, but there was no significant difference between the two donor types (p > 0.05). However, vWF reactivity might be an early indicator for loss of tissue integrity, while C4d deposition and activated C3 might be better predictors for histological damage. Conclusions: Similar characteristics of DCD were shown in comparison with DBD kidneys. Importantly, the additional warm ischemic time in DCD appeared to have no further detectable adverse effects on tissue injury, inflammation and complement activation. vWF, C4d and C3 might be potential biomarkers facilitating the evaluation of donor kidneys.

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Use of ex vivo normothermic machine perfusion after normothermic regional perfusion to salvage a poorly perfused DCD kidney

Abstract: Abbreviations: CIT, cold ischemia time; DCD, donation after circulatory death; NMP, normothermic machine perfusion; NRP, normothermic regional perfusion; RBF, renal blood flow.

Cited by 14 publications

References 21 publications

Advances in Kidney Preservation Techniques and Their Application in Clinical Practice

Advances in Kidney Preservation Techniques and Their Application in Clinical Practice

Macroscopic assessment of the quality of cold perfusion after deceased‐donor kidney procurement: A United Kingdom population‐based cohort study

Comparative Analysis of Risk Factors in Declined Kidneys from Donation after Brain Death and Circulatory Death

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