Analysis of local versus imported expanded criteria donor kidneys: A single‐center experience with 497 ECD kidney transplants

Abstract

Midterm outcomes are remarkably similar for import vs local ECD KTs, suggesting that broader sharing of ECD kidneys may improve utilization without compromising outcomes.

Strategies to Restore Adenosine Triphosphate (ATP) Level After More than 20 Hours of Cold Ischemia Time in Human Marginal Kidney Grafts

“…Many case series have reported CIT values between 10 and 18 hours [ 8 , 9 ] and >30 hours [ 7 ]. Often, CIT is secondary to recipient selection and dialysis before transplantation.…”

Long‐term outcomes of kidney transplantation from deceased donors with terminal acute kidney injury: Single center experience and literature review

“…Whenever possible, AKI donor kidneys were placed on machine perfusion preservation to minimize preservation injury, maintain functional reserve, and provide another means of assessment 26,27,31,32 . Most of the imported kidneys in this experience were shipped to us in cold storage and placed on the Organ Recovery Systems pump by our local organ procurement organization for a variable period prior to implantation 33 . Although pump parameters were not exclusively used to discard kidneys, a terminal flow rate >80 ml/min and a resistance <.40 mm Hg/ml/min after a minimum of 6 h on the machine perfusion apparatus were considered thresholds for single kidney utilization 29,31 .…”

“…26,27,31,32 Most of the imported kidneys in this experience were shipped to us in cold storage and placed on the Organ Recovery Systems pump by our local organ procurement organization for a variable period prior to implantation. 33 Although pump parameters were not exclusively used to discard kidneys, a terminal flow rate >80 ml/min and a resistance <.40 mm Hg/ml/min after a minimum of 6 h on the machine perfusion apparatus were considered thresholds for single kidney utilization. 29,31 However, again with increased experience and application of dual kidney transplantation, these criteria were liberalized and included 10 cases with a terminal flow rate < 80 ml/min and 9 (including 4 with a low terminal flow rate) with a terminal resistance ≥.4 mm Hg/ml/min.…”

Eversion endarterectomy of the deceased donor renal artery to prevent kidney discard

“…Herein we describe our single‐center experience with RA EE as a method of graft salvage in 17 patients undergoing KT. The majority of these kidneys were imported from other DSAs, suggesting that multiple centers had refused these kidneys prior to acceptance by our center . Moreover, most of these kidneys would probably have been discarded in the absence of our rescue utilization.…”

“…The majority of these kidneys were imported from other DSAs, suggesting that multiple centers had refused these kidneys prior to acceptance by our center. 42 Moreover, most of these kidneys would probably have been discarded in the absence of our rescue utilization. Many transplant programs regard severe DD aortic and RA atherosclerosis as a surrogate marker for intra-renal atherosclerosis and intrinsic renal parenchymal disease.…”