In Situ Preservation of Cadaver Kidneys for Transplantation

Abstract

Many kidneys obtained from cadaver donors undergoing sudden cardiac arrest cannot be transplanted due to the long periods of warm ischemia from the moment of arrest to nephrectomy. A double-ballon-triple-lumen catheter for the rapid in situ preservation of cadaver kidneys has been designed. Used in combination with equipment routinely found in any hospital, it can cool human kidneys in situ to 10-15 C and maintain this temperature until nephrectomy can be performed. Kidenys preserved with this catheter have functioned after transplantation into suitable recipients. This report describes the design and laboratory evaluation of this new device, its clinical effectiveness and technique of insertion.

Improved Outcomes of Renal Transplantation from Cardiac Death Donors: A 30-Year Single Center Experience

“…All donors were categorized as either III or IV based on the Maastricht criteria (7). The kidneys were allocated on the basis of ABO compatibility, clinical need, waiting time and HLA matching.…”

“…We have performed renal transplantation (RTx) from DCD donors with an in situ cooling technique using a double balloon catheter for organ procurement since the 1970s. This catheter is specifically designed for selective in situ perfusion of the intraabdominal organs with cold solution that was originally described by Garcia-Rinaldi et al (7,8). In this study, the short-and long-term outcomes of RTx from DCD donors over 30 years were retrospectively analyzed.…”

Preservation of Human Pancreatic Islet in Vivo Function After 6-Month Culture in Serum-Free Media1

“…One study showed that a combination of low doses of both SRL and CsA was effective to avoid nephrotoxicity in a rat model (27). Another study using an ex vivo whole-blood assay and adrenalectomized rats found a synergistic effect on the inhibition of [ 3 H]-incorporation for the combination of SRL plus prednisolone (15).…”

Use of Non-Heart-Beating Donor Kidneys for Transplantation

“…These resulted in 66 kidneys suitable for transplanta tion, 10 being discarded because of traumatic damage to the graft prior to nephrectomy in 6, no recipient found in 2, multiple arteries in 1, and technical failure in 1. In situ perfusion with Collins' solution, using an intra-aortic double balloon catheter, was employed for the rapid cooling of 39 kidneys [8,9]. The mean warm ischemia time for the entire group was 2 1 min (range 3-45).…”