Ex situ machine perfusion in kidney transplantation

Bouari, Sarah; Rijkse, Elsaline; Hosgood, Sarah A.; Minnee, Robert C.

doi:10.1111/aor.14134

Cited by 5 publications

(6 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The methods have the potential to cost-effectively increase the number of organs available for transplantation, to improve marginal organs before transplantation, and to reduce the transplantation of less viable organs. 125,126…”

Section: Cost-effectiveness Of Udcd With Ongoing Ecpr and Ecmo For Or...mentioning

confidence: 99%

Organ Donation After Out-of-Hospital Cardiac Arrest: A Scientific Statement From the International Liaison Committee on Resuscitation

Morrison¹,

Sandroni²,

Grunau³

et al. 2023

Circulation

View full text Add to dashboard Cite

Aim of the Review: Improving rates of organ donation among patients with out-of-hospital cardiac arrest who do not survive is an opportunity to save countless lives. The objectives of this scientific statement were to do the following: define the opportunity for organ donation among patients with out-of-hospital cardiac arrest; identify challenges and opportunities associated with organ donation by patients with cardiac arrest; identify strategies, including a generic protocol for organ donation after cardiac arrest, to increase the rate and consistency of organ donation from this population; and provide rationale for including organ donation as a key clinical outcome for all future cardiac arrest clinical trials and registries. Methods: The scope of this International Liaison Committee on Resuscitation scientific statement was approved by the International Liaison Committee on Resuscitation board and the American Heart Association, posted on ILCOR.org for public comment, and then assigned by section to primary and secondary authors. A unique literature search was completed and updated for each section. Results: There are a number of defining pathways for patients with out-of-hospital cardiac arrest to become organ donors; however, modifications in the Maastricht classification system need to be made to correctly identify these donors and to report outcomes with consistency. Suggested modifications to the minimum data set for reporting cardiac arrests will increase reporting of organ donation as an important resuscitation outcome. There are a number of challenges with implementing uncontrolled donation after cardiac death protocols, and the greatest impediment is the lack of legislation in most countries to mandate organ donation as the default option. Extracorporeal cardiopulmonary resuscitation has the potential to increase organ donation rates, but more research is needed to derive neuroprognostication rules to guide clinical decision-making about when to stop extracorporeal cardiopulmonary resuscitation and to evaluate cost-effectiveness. Conclusions: All health systems should develop, implement, and evaluate protocols designed to optimize organ donation opportunities for patients who have an out-of-hospital cardiac arrest and failed attempts at resuscitation.

show abstract

Section: Cost-effectiveness Of Udcd With Ongoing Ecpr and Ecmo For Or...mentioning

confidence: 99%

Organ Donation After Out-of-Hospital Cardiac Arrest: A Scientific Statement From the International Liaison Committee on Resuscitation

Morrison¹,

Sandroni²,

Grunau³

et al. 2023

Circulation

View full text Add to dashboard Cite

show abstract

“…10 Renal flow and IRR are the most intuitive ways to assess the viability of the NMP kidney, although the LK group showed inferior performance. 15 However, it is not reliable to simply associate the increase of vascular resistance with tissue damage after ischemic and inflammatory insults. 16 Vasoconstrictors, such as angiotensinogen produced in the liver and converted to angiotensin II, can cause vasoconstriction, reducing renal flow and further decreasing urine production.…”

Section: Discussionmentioning

confidence: 99%

“…Renal flow and IRR are the most intuitive ways to assess the viability of the NMP kidney, although the LK group showed inferior performance 15 . However, it is not reliable to simply associate the increase of vascular resistance with tissue damage after ischemic and inflammatory insults 16 .…”

Section: Discussionmentioning

confidence: 99%

Addition of a liver to the normothermic perfusion circuit reduces renal pro‐inflammatory factors

Zhang

Ruan

et al. 2023

Artificial Organs

View full text Add to dashboard Cite

BackgroundNormothermic machine perfusion (NMP) provides a novel platform to preserve isolated organs in an artificial condition. Our study aimed to explore the interaction between the liver and kidney at an ex vivo organ level by adding a liver to the kidney NMP circuit.MethodsPorcine kidney and liver obtained from abattoir were subjected to 9 h NMP after suffering 30‐min warm ischemia time and 90‐min cold ischemia time. The liver–kidney NMP group (n = 5) and the single‐kidney NMP group (n = 5) were designed. During the NMP, perfusion parameters, blood gas analysis, and tissue samples were compared.ResultsThe perfusate of both groups remained stable, and continuous urine production was observed during NMP. In the liver–kidney NMP group, the lactate level was low, while blood urea nitrogen increased and glucose levels decreased. After the NMP, the renal tissue in the liver–kidney group exhibited fewer histological changes such as tubular epithelium vacuolization, along with reduced expression of IL‐6, IL‐8, IL‐1β, NLRP3, and GSDMD.ConclusionsOur results indicated that the expression of renal pro‐inflammatory factors was reduced in the liver–kidney NMP system.

show abstract

“…Normothermic (35-37°C) machine perfusion (NMP) has emerged as a promising platform for assessing renal suitability for transplantation. [1][2][3] To increase the diagnostic potential of NMP, biomarkers and functional tests are needed that can provide adequate information about the quality of the kidney during perfusion. In addition, to ensure minimal additional injury to the already damaged kidneys, their preservation during NMP must be optimized by incorporating protective additives into the perfusate.…”

Section: Introductionmentioning

confidence: 99%

“…Normothermic (35–37°C) machine perfusion (NMP) has emerged as a promising platform for assessing renal suitability for transplantation 1–3 . To increase the diagnostic potential of NMP, biomarkers and functional tests are needed that can provide adequate information about the quality of the kidney during perfusion.…”

Section: Introductionmentioning

confidence: 99%

Furosemide attenuates tubulointerstitial injury and allows functional testing of porcine kidneys during normothermic machine perfusion

Ogurlu,

Hamelink,

Lantinga

et al. 2024

Artificial Organs

View full text Add to dashboard Cite

BackgroundNormothermic machine perfusion (NMP) is a promising pretransplant kidney quality assessment platform, but it remains crucial to increase its diagnostic potential while ensuring minimal additional injury to the already damaged kidney. Interventions that alter tubular transport can influence renal function and injury during perfusion. This study aimed to determine whether furosemide and desmopressin affect renal function and injury during NMP.MethodsEighteen porcine kidneys (n = 6 per group) were subjected to 30 min of warm ischemia and 4 h of oxygenated hypothermic perfusion before being subjected to 6 h of NMP. Each organ was randomized to receive no drug, furosemide (750 mg), or desmopressin (16 μg) during NMP.ResultsCompared with the other groups, the addition of furosemide resulted in significantly increased urine output, fractional excretion of sodium and potassium, and urea clearance during NMP. Urinary neutrophil gelatinase‐associated lipocalin levels decreased significantly with furosemide supplementation compared with the other groups. The addition of desmopressin did not result in any significantly different outcome measurements compared with the control group.ConclusionsThis study showed that the addition of furosemide affected renal function while attenuating tubulointerstitial injury during NMP. Therefore, furosemide supplementation may provide renal protection and serve as a functional test for pretransplant kidney viability assessment during NMP.

show abstract

Ex situ machine perfusion in kidney transplantation

Cited by 5 publications

References 11 publications

Organ Donation After Out-of-Hospital Cardiac Arrest: A Scientific Statement From the International Liaison Committee on Resuscitation

Organ Donation After Out-of-Hospital Cardiac Arrest: A Scientific Statement From the International Liaison Committee on Resuscitation

Addition of a liver to the normothermic perfusion circuit reduces renal pro‐inflammatory factors

Furosemide attenuates tubulointerstitial injury and allows functional testing of porcine kidneys during normothermic machine perfusion

Contact Info

Product

Resources

About