A comparison of the results of renal transplantation from non–heart-beating, conventional cadaveric, and living donors

Nicholson, Michael L.; Metcalfe, Matthew S.; White, Steven A.; Waller, J.R.; Doughman, T; Horsburgh, T.; Feehally, John; Carr, Sue; Veitch, P. S.

doi:10.1046/j.1523-1755.2000.00445.x

“…[3][4][5][12][13][14] Other studies have reported poor renal function with such prolonged ischemia times. 14,15 It would seem that kidneys with tumours amenable to partial nephrectomy may not be subjected to the same global stress as kidneys with major trauma or physiologic events surrounding the death of cadaveric kidney donors and hence may tolerate longer WIT.…”

Section: Discussionmentioning

confidence: 99%

Renal histopathology features according to various warm ischemia times in porcine laparoscopic and open surgery model

Robert¹,

Chawla²,

Tisdale³

et al. 2011

CUAJ

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Background: Thirty minutes has been considered as the threshold for tolerable warm ischemic time (WIT). Recent reports demonstrate recovery of renal function after longer WIT. We assessed renal histology according to different WIT in a 2-kidney porcine model. Methods: Twelve female pigs were randomized to an open or laparoscopic group. Each pig was further randomized within each group to clamping the left renal artery for 5, 15, 30, 45, 60 or 180 minutes. Preclamping left renal biopsies were performed on each pig. The contralateral kidney in each animal was used as an individual control. On postoperative day 14, all animals underwent bilateral nephrectomies. Preclamping left renal biopsies and all renal specimens were evaluated by a blinded veterinary pathologist. Results: One pig died in the open group after 180 minutes of clamping. Histopathology did not show any significant changes between the two groups and across clamp times from 5 to 60 minutes. After 180 minutes of laparoscopic clamping, there was evidence of diffuse necrosis. Interpretation: Sixty minutes of ischemia did not show any permanent renal damage in both groups. Further studies are needed to verify these findings in humans. A prolonged ischemic time without permanent renal damage would be helpful in partial nephrectomy. Warm ischemic time of 180 minutes exceeded the renal ischemic burden based on histological features.

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“…7,16 -19 The effect of kidney graft size and recipient weight (Rw) 20,21 has also been studied; however, the direct impact of matching the Kw itself (which correlates with both glomerular volume and nephron number) 15 to the Rw has been studied only in relatively small cohorts of Ͻ300 patients and only in living donors, 22,23 where the graft does not incur the same accumulating injuries as those from deceased donors.…”

mentioning

confidence: 99%

Kidney and Recipient Weight Incompatibility Reduces Long-Term Graft Survival

Giral¹,

Foucher²,

Karam³

et al. 2010

Journal of the American Society of Nephrology

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Long-term function of kidney allografts depends on multiple variables, one of which may be the compatibility in size between the graft and the recipient. Here, we assessed the long-term consequences of the ratio of the weight of the kidney to the weight of the recipient (KwRw ratio) in a multicenter cohort of 1189 patients who received a transplant between 1995 and 2006. The graft filtration rate increased by a mean of 5.74 ml/min between the third and sixth posttransplantation months among patients with a low KwRw ratio (Ͻ2.3 g/kg; P Ͻ 0.0001). In this low KwRw ratio group, the graft filtration rate remained stable between 6 months and 7 years but then decreased at a mean rate of 3.17 ml/min per yr (P Ͻ 0.0001). In addition, low KwRw ratios conferred greater risk for proteinuria, more antihypertensive drugs, and segmental or global glomerulosclerosis. Moreover, a KwRw ratio Ͻ2.3 g/kg associated with a 55% increased risk for transplant failure by 2 years of follow-up. In conclusion, incompatibility between graft and recipient weight is an independent predictor of long-term graft survival, suggesting that avoiding kidney and recipient weight incompatibility may improve late clinical outcome after kidney transplantation.

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“…[3][4][5][12][13][14] Other studies have reported poor renal function with such prolonged ischemia times. 14,15 It would seem that kidneys with tumours amenable to partial nephrectomy may not be subjected to the same global stress as kidneys with major trauma or physiologic events surrounding the death of cadaveric kidney donors and hence may tolerate longer WIT.…”

Section: Discussionmentioning

confidence: 99%

Renal histopathology features according to various warm ischemiatimes in porcine laparoscopic and open surgery model

Sabbagh

¹

,

Chawla

²

,

Tisdale

³

et al. 2013

CUAJ

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Background: Thirty minutes has been considered as the threshold for tolerable warm ischemic time (WIT). Recent reports demonstrate recovery of renal function after longer WIT. We assessed renal histology according to different WIT in a 2-kidney porcine model. Methods: Twelve female pigs were randomized to an open or laparoscopic group. Each pig was further randomized within each group to clamping the left renal artery for 5, 15, 30, 45, 60 or 180 minutes. Preclamping left renal biopsies were performed on each pig. The contralateral kidney in each animal was used as an individual control. On postoperative day 14, all animals underwent bilateral nephrectomies. Preclamping left renal biopsies and all renal specimens were evaluated by a blinded veterinary pathologist. Results: One pig died in the open group after 180 minutes of clamping. Histopathology did not show any significant changes between the two groups and across clamp times from 5 to 60 minutes. After 180 minutes of laparoscopic clamping, there was evidence of diffuse necrosis. Interpretation: Sixty minutes of ischemia did not show any permanent renal damage in both groups. Further studies are needed to verify these findings in humans. A prolonged ischemic time without permanent renal damage would be helpful in partial nephrectomy. Warm ischemic time of 180 minutes exceeded the renal ischemic burden based on histological features.

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A comparison of the results of renal transplantation from non–heart-beating, conventional cadaveric, and living donors

Abstract: Despite being associated with poor initial graft function, the long-term allograft survival of NHBD kidneys does not differ significantly from the results of HBD and LD transplants.

Cited by 184 publications

References 14 publications

Renal histopathology features according to various warm ischemia times in porcine laparoscopic and open surgery model

Renal histopathology features according to various warm ischemia times in porcine laparoscopic and open surgery model

Kidney and Recipient Weight Incompatibility Reduces Long-Term Graft Survival

Renal histopathology features according to various warm ischemiatimes in porcine laparoscopic and open surgery model

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