Hypothermic machine perfusion in kidney transplantation

Deken, Julie De; Kocabayoglu, Peri; Moers, Cyril

doi:10.1097/mot.0000000000000306

Cited by 53 publications

(52 citation statements)

References 30 publications

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“…However, the quality of these organs may not be as good as standard donor organs. Hypothermic machine perfusion has re-emerged as a research hotspot (28). Increasing researches showed that HMP can significantly reduce the incidence of DGF and can provide better preservation and repair functions for the grafts.…”

Section: Discussionmentioning

confidence: 99%

Hypothermic Machine Perfusion Versus Static Cold Storage in Deceased Donor Kidney Transplantation: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials

Peng

Ding

et al. 2018

Artificial Organs

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Static cold storage (SCS) and hypothermic machine perfusion (HMP) are two primary options for renal allograft preservation. Compared with SCS, HMP decreased the incidence of delayed graft function (DGF) and protected graft function. However, more evidence is still needed to prove the advantages of the HMP. In this study, the outcomes of kidney grafts from the two preservation methods were compared by conducting a systematic review and meta-analysis. Randomized controlled trials (RCTs) comparing the effect of hypothermic machine perfusion and static cold storage in deceased donor kidney transplantation were identified through searches of the MEDLINE, EMBASE, and Cochrane databases between January 1, 1980 and December 30, 2017. The primary endpoints were delayed graft function and graft survival. Secondary endpoints included primary non-function (PNF), graft renal function, duration of DGF, acute rejection, postoperative hospital stay and patient survival. Summary effects were calculated as risk ratio (RR) with 95% confidence interval (CI) or mean difference (MD) with 95% confidence intervals (CI). A total of 13 RCTs were included, including 2048 kidney transplant recipients. The results indicated that compared with SCS, HMP decreased the incidence of DGF (RR 0.78, 95% CI 0.69-0.87, P < 0.0001), and improved the graft survival at 3 years (RR 1.06, 95% CI 1.02-1.11, P = 0.009). There was no significant difference in other endpoints. HMP might be a more desirable method of preservation for kidney grafts. The long-term outcomes of kidney allografts stored by hypothermic machine perfusion still need to be further investigated.

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Section: Discussionmentioning

confidence: 99%

Hypothermic Machine Perfusion Versus Static Cold Storage in Deceased Donor Kidney Transplantation: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials

Peng

Ding

et al. 2018

Artificial Organs

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“…In comparison to the severely reduced quality of life and life expectancy on the transplant waiting list, the transplantation of kidneys that are presumed to be of less than optimal quality may still provide a significant health benefit to the recipient . In addition, hypothermic machine perfusion has been proposed as a method to salvage marginal organs that otherwise may be discarded …”

Section: Introductionmentioning

confidence: 99%

“…4 In addition, hypothermic machine perfusion has been proposed as a method to salvage marginal organs that otherwise may be discarded. 6 The use of kidneys from deceased donors with acute kidney injury (AKI) at the time of donation is another method by which to expand the donor pool. As AKI often fully recovers, discarding kidneys with AKI is potentially a missed opportunity to cure more patients with ESRD.…”

Section: Introductionmentioning

confidence: 99%

Donor acute kidney injury and its effect on 1‐year post‐transplant kidney allograft fibrosis

Windt

Mehta

Jorgensen

et al. 2020

Clinical Transplantation

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Transplantation of kidneys from deceased donors with acute kidney injury (AKI) can expand the donor pool. We investigated the effect of donor AKI on renal function and chronic changes on protocol biopsies at 1‐year post‐transplant. Donor AKI was defined according to Acute Kidney Injury Network (AKIN) criteria. Between 2013 and 2017, 333 kidneys were transplanted and subsequently biopsied after 1 year. Fifty‐three kidneys from AKI donors (AKIN stage I n = 42, stage II n = 8, stage III n = 3) were compared to 280 kidneys from non‐AKI donors. At 1‐year follow‐up, patient and graft survival were comparable. Donor AKI was not predictive of IFTA (Banff interstitial fibrosis plus tubular atrophy scores) at 1‐year post‐transplant biopsy (2.10 ± 1.28 in AKI, 2.09 ± 1.22 in non‐AKI, P = .95). Donor AKI was also not associated with progression of IFTA from 3 to 12 months (P = .69), or inferior glomerular filtration rate (eGFR, P = .94). In a multivariate analysis, the odds of IFTA >2 were comparable between AKI and non‐AKI groups. In conclusion, the transplantation of kidneys from donors with predominantly stage I AKI results in comparable function and degree of fibrosis on protocol biopsies 1‐year post‐transplant. Selected grafts from donors with AKI are a valuable tool for expanding the donor pool for kidney transplantation.

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“…The first device approved in the US by the FDA for kidney preservation in 2009 perfused the organs at 4°C without oxygenation (Moers et al, 2009). Unfortunately, this generation of devices had limited impact in both graft and patient survival 5 years after transplantation and became obsolete (De Deken et al, 2016). Subsequent MP devices were developed that instead preserved organs under normothermic (37°C) conditions and used oxygen carrier solutions for perfusate.…”

Section: Introductionmentioning

confidence: 99%

Machine Perfusion of Porcine Livers with Oxygen-Carrying Solution Results in Reprogramming of Dynamic Inflammation Networks

et al. 2016

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Background: Ex vivo machine perfusion (MP) can better preserve organs for transplantation. We have recently reported on the first application of an MP protocol in which liver allografts were fully oxygenated, under dual pressures and subnormothermic conditions, with a new hemoglobin-based oxygen carrier (HBOC) solution specifically developed for ex vivo utilization. In those studies, MP improved organ function post-operatively and reduced inflammation in porcine livers. Herein, we sought to refine our knowledge regarding the impact of MP by defining dynamic networks of inflammation in both tissue and perfusate.Methods: Porcine liver allografts were preserved either with MP (n = 6) or with cold static preservation (CSP; n = 6), then transplanted orthotopically after 9 h of preservation. Fourteen inflammatory mediators were measured in both tissue and perfusate during liver preservation at multiple time points, and analyzed using Dynamic Bayesian Network (DyBN) inference to define feedback interactions, as well as Dynamic Network Analysis (DyNA) to define the time-dependent development of inflammation networks.Results: Network analyses of tissue and perfusate suggested an NLRP3 inflammasome-regulated response in both treatment groups, driven by the pro-inflammatory cytokine interleukin (IL)-18 and the anti-inflammatory mediator IL-1 receptor antagonist (IL-1RA). Both DyBN and DyNA suggested a reduced role of IL-18 and increased role of IL-1RA with MP, along with increased liver damage with CSP. DyNA also suggested divergent progression of responses over the 9 h preservation time, with CSP leading to a stable pattern of IL-18-induced liver damage and MP leading to a resolution of the pro-inflammatory response. These results were consistent with prior clinical, biochemical, and histological findings after liver transplantation.Conclusion: Our results suggest that analysis of dynamic inflammation networks in the setting of liver preservation may identify novel diagnostic and therapeutic modalities.

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Hypothermic machine perfusion in kidney transplantation

Cited by 53 publications

References 30 publications

Hypothermic Machine Perfusion Versus Static Cold Storage in Deceased Donor Kidney Transplantation: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials

Hypothermic Machine Perfusion Versus Static Cold Storage in Deceased Donor Kidney Transplantation: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials

Donor acute kidney injury and its effect on 1‐year post‐transplant kidney allograft fibrosis

Machine Perfusion of Porcine Livers with Oxygen-Carrying Solution Results in Reprogramming of Dynamic Inflammation Networks

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