Application of Machine Perfusion Preservation as a Viability Test for Marginal Kidney Graft

Matsuno, Naoto; Konno, Osamu; Mejit, Abudushukur; Jyojima, Y.; Akashi, Isao; Nakamura, Yuki; Iwamoto, Hitoshi; Hama, K.; Iwahori, Tohru; Ashizawa, T.; Nagao, Toshiyasu

doi:10.1097/01.tp.0000243733.77706.99

Cited by 50 publications

(29 citation statements)

References 5 publications

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“…In addition to the intended benefit of improved tissue preservation, machine perfusion also provides the opportunity to determine perfusion parameters including perfusion pressure, perfusion flow and renovascular resistance. These parameters have been advocated to predict graft function after transplantation (7)(8)(9)(10). The assessment of organ viability is especially important in marginal kidneys with their increased risk of developing PNF.…”

Section: Introductionmentioning

confidence: 99%

Renovascular Resistance of Machine-Perfused DCD Kidneys Is Associated with Primary Nonfunction

Vries

Hoogland

Winkens

et al. 2011

American Journal of Transplantation

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Donation after cardiac death (DCD) has shown to be a valuable extension of the donor pool despite a higher percentage of primary nonfunction (PNF). Limiting the incidence of PNF is of vital importance. Renovascular resistance is believed to predict graft outcome; however the literature is inconsistent. Therefore, we studied whether renovascular resistance is associated with PNF and whether this parameter should be used to discard donor kidneys. All transplanted DCD kidneys preserved by machine perfusion at our center between 1993 and 2007 were analyzed (n = 440). The effects of renovascular resistance on PNF, delayed graft function (DGF), and graft and patient survival were examined using multivariable analyses; predictive quality by calculating the area under the curve (AUC). We showed that renovascular resistance at the start of machine perfusion was significantly and independently associated with PNF (OR 2.040, 95% CI 1.362-3.056; p = 0.001), and DGF (OR 2.345, 95% CI 1.110-4.955; p = 0.025). Predictive quality was moderate (0.609, 95% CI 0.538-0.681). Graft and patient survival were not associated with renovascular resistance. We conclude that renovascular resistance in DCD kidneys is an independent risk factor for PNF; however, the predictive value is relatively low.

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Section: Introductionmentioning

confidence: 99%

Renovascular Resistance of Machine-Perfused DCD Kidneys Is Associated with Primary Nonfunction

Vries

Hoogland

Winkens

et al. 2011

American Journal of Transplantation

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“…Esto resultaría muy importante en los programas de órganos de DCP. Proporciona la opción de administrar sustratos metabólicos a la célula a través de la solución de perfusión, y la posibilidad de modificar la resistencia vascular, ya sea por la propia perfusión como por maniobras farmacológicas 31 . Los parámetros hemodinámicos que se establecen como punto de corte para rechazar un órgano para su trasplante varían según los autores.…”

Section: Discussionunclassified

“…Matsuno rechazaría órganos con un FVR <0,4 ml/min/gr. y un patrón de RVR con tendencia ascendente 31 . Otros autores consideran como un parámetro favorable y suficiente que la RVR se reduzca durante el tiempo de perfusión 24 .…”

Section: Discussionunclassified

Caracterización histológica y hemodinámica del injerto con isquemia caliente según el método de preservación

et al. 2008

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órganos de donantes a corazón parado abre una vía para solucionar la escasez de órganos para trasplante. Por la naturaleza de estos donantes los riñones sufren un periodo variable de isquemia normotérmica (IN) antes de su extracción, que puede dañar el injerto y condicionar su supervivencia. Minimizar el daño producido al riñón durante la extracción, los diferentes tipos de conservación hipotérmica y su posterior trasplante resulta clave para mejorar los resultados obtenidos con este tipo de injertos.Pretendemos evaluar mediante un modelo experimental, que somete al injerto renal a un periodo de IN, las consecuencias estructurales y hemodinámicas de la perfusión hipotérmica (PH) frente a la hipotermia simple (HS). Todo el procedimiento fue monitorizado y registrado mediante un sistema informatizado. La resistencia vascular renal (RVR) y el flujo vascular renal (FVR) fueron registrados en tiempo real tras el desclampaje. Llevamos a cabo estudio histológico mediante microscopía convencional y electrónica.Resultados: Observamos 2 patrones evolutivos post-trasplante: 1. Incremento inicial de RVR con descenso posterior e incremento del flujo vascular: órganos con IN y PH previa al trasplante (grupo B) // órganos sin isquemia previa y trasplante (grupo C-control). Microscopía convencional-electrónica: integridad túbulo-endotelial.2. Descenso inicial de RVR con incremento posterior: órganos con IN y trasplante directo (A)//órganos con isquemia previa e HS de 60 min. (D). Alteraciones túbulo-endoteliales en micro convencional-electrónica.Conclusiones: La PH en bomba preserva mejor, a nivel experimental, la ultraestructura túbulo-endotelial de los riñones sometidos a IN prolongada. La hemodinámica post-trasplante de los órganos sometidos isquemia y PH sigue un patrón similar a la de los órganos sin IN previa y trasplantados directamente.Palabras clave: Isquemia normotérmica. Preservación de órganos. ABSTRACT HYSTOLOGIC AND HEMODYNAMIC ASPECTS OF WARM ISCHEMIC GRAFT IN RELATION TO THE PRESERVATION METHODObjective: The non-heart-beating donor has been proposed as a solution to donor shortage for renal transplantation. Because the nature of such donors, the kidneys so derived have been damaged by primary warm ischemia (WI), and so potentially they may never function. Minimizing graft injury is especially important in case of transplantation form marginal donors because of a high rate of delayed graft function or primary nonfunction. The aim of this experimental study is to assess the structural and hemodynamic consequences of hypothermic perfusion (HP) versus cold storage (CS), in renal allograft after a period of WI.Material and Methods: We used 20 mini-pigs. WI was achieved by vascular pedicle occlusion during 45 min. We divided organs in 4 groups: A (n=5), kidneys with WI and then transplanted; group B (n=5), grafts with WI and implanted after HP with Belzer solution in our computerized perfusion system. Group C-control, (n=5) transplanted without WI and D (n=5) with WI and 60 min of CS in UW-Viaspan solution.All the pro...

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“…18 Further research by the group confirmed the correlation between flow rates and immediate function and primary nonfunction. [18][19] Both studies showed high rates of acute tubular necrosis, but this resolved faster in kidneys with higher flow rates. [18][19] The importance of flow rates was highlighted further by Balupuri and associates, with a case of immediate nonfunction in a graft with acceptable perfusate biomarkers and perfusion pressures, but a low flow rate (26 mL/min/100 g).…”

Section: Machine Perfusion Pressuresmentioning

confidence: 99%

Advances in Machine Perfusion Graft Viability Assessment in Kidney, Liver, Pancreas, Lung, and Heart Transplant

Balfoussia

Yerrakalva²,

Hamaoui³

et al. 2012

Exp Clin Transplant

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Application of Machine Perfusion Preservation as a Viability Test for Marginal Kidney Graft

Abstract: MPF is a reliable indicator of graft viability based on the rate of PNF and immediate renal allograft function, especially in marginal donors.

Cited by 50 publications

References 5 publications

Renovascular Resistance of Machine-Perfused DCD Kidneys Is Associated with Primary Nonfunction

Renovascular Resistance of Machine-Perfused DCD Kidneys Is Associated with Primary Nonfunction

Caracterización histológica y hemodinámica del injerto con isquemia caliente según el método de preservación

Advances in Machine Perfusion Graft Viability Assessment in Kidney, Liver, Pancreas, Lung, and Heart Transplant

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