Machine perfusion viability testing

Smaalen, Tim C. van; Hoogland, E.R. Pieter; Heurn, L. W. Ernest van

doi:10.1097/mot.0b013e32835e2a1b

Cited by 30 publications

(18 citation statements)

References 44 publications

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“…Machine preservation characteristics are commonly used for graft selection of DBD and DCD kidneys; however, the level of evidence of the benefits of this selection is usually poor. Results are often biased, as kidneys with high intrarenal resistance are not transplanted . Two studies, in which kidneys were transplanted irrespective of intrarenal resistance, one including both DBD and DCD kidneys and the other DCD kidneys only, showed that intrarenal resistance was an independent risk factor for PNF, DGF and 1‐year graft survival .…”

Section: Preservation Of Dcd Kidneysmentioning

confidence: 99%

Recommendations for donation after circulatory death kidney transplantation in Europe

Heurn

Talbot

Nicholson³

et al. 2015

Transpl Int

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SUMMARY Donation after circulatory death (DCD) donors provides an invaluable source for kidneys for transplantation. Over the last decade, we have observed a substantial increase in the number of DCD kidneys, particularly within Europe. We provide an overview of risk factors associated with DCD kidney function and survival and formulate recommendations from the sixth international conference on organ donation in Paris, for bestpractice guidelines. A systematic review of the literature was performed using Ovid Medline, Embase and Cochrane databases. Topics are discussed, including donor selection, organ procurement, organ preservation, recipient selection and transplant management.

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Section: Preservation Of Dcd Kidneysmentioning

confidence: 99%

Recommendations for donation after circulatory death kidney transplantation in Europe

Heurn

Talbot

Nicholson³

et al. 2015

Transpl Int

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“…renal grafts for transplantation 22. Other studies investigated machine perfusate biomarkers, such as LDH and AST (nonspecific markers of cellular injury), glutathione-S-transferase (a renal tubular enzyme, associated with proximal tubular injury), N-acetylβd-glucosaminidase, heart-type fatty acid binding protein, redox-active iron, interleukin-18, lipid peroxidation products, neutrophil gelatinase-associated lipocalin, and ionized calcium 3,23. Similar to IRR, some perfusate biomarkers correlate with posttransplantation renal function such as DGF 24 but do not represent stand-alone tools for acceptance or rejection of renal grafts for transplantation.Stubenitsky and colleagues developed a renal graft perfusion system called exsanguinous metabolic support for graft storage and repair at near-physiologic temperatures of 32°C 25.…”

mentioning

confidence: 99%

Normothermic ex vivo kidney perfusion for graft quality assessment prior to transplantation

Kaths

Hamar

Echeverri

et al. 2018

American Journal of Transplantation

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Normothermic ex vivo kidney perfusion (NEVKP) represents a novel approach for graft preservation and functional improvement in kidney transplantation. We investigated whether NEVKP also allows graft quality assessment before transplantation. Kidneys from 30-kg pigs were recovered in a model of heart-beating donation (group A) after 30 minutes (group B) or 60 minutes (group C) (n = 5/group) of warm ischemia. After 8 hours of NEVKP, contralateral kidneys were resected, grafts were autotransplanted, and the pigs were followed for 3 days. After transplantation, renal function measured based on peak serum creatinine differed significantly among groups (P < .05). Throughout NEVKP, intrarenal resistance was lowest in group A and highest in group C (P < .05). intrarenal resistance at the initiation of NEVKP correlated with postoperative renal function (P < .001 at NEVKP hour 1). Markers of acid-base homeostasis (pH, HCO , base excess) differed among groups (P < .05) and correlated with posttransplantation renal function (P < .001 for pH at NEVKP hour 1). Similarly, lactate and aspartate aminotransferase were lowest in noninjured grafts versus donation after circulatory death kidneys (P < .05) and correlated with posttransplantation kidney function (P < .001 for lactate at NEVKP hour 1). In conclusion, assessment of perfusion characteristics and clinically available perfusate biomarkers during NEVKP allows the prediction of posttransplantation graft function. Thus, NEVKP might allow decision-making regarding whether grafts are suitable for transplantation.

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“…Subsequent analyses of the trial found high renal resistance at the end of machine perfusion to be an independent risk factor for both DGF and 1-year graft failure (32). As other investigators have also suggested (33), additional studies are urgently needed to discern the role of perfusion parameters in the decision process for allograft selection and organ discard, and we believe the potential utility of perfusate biomarkers of kidney injury deserves further investigation as well. Perfusate biomarkers were natural log-transformed and added individually to all models (i.e.…”

Section: Perfusate Gst and Dgfmentioning

confidence: 91%

Glutathione S-Transferase Iso-Enzymes in Perfusate From Pumped Kidneys Are Associated With Delayed Graft Function

Hall

Bhangoo

Reese

et al. 2014

American Journal of Transplantation

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Accurate and reliable assessment tools are needed in transplantation. The objective of this prospective, multicenter study was to determine the associations of the alpha and pi iso-enzymes of glutathione S-transferase (GST), measured from perfusate solution at the start and end (base and post) of kidney allograft machine perfusion, with subsequent delayed graft function (DGF). We also compared GST iso-enzyme perfusate levels from discarded versus transplanted kidneys. A total of 428 kidneys were linked to outcomes as recorded by the United Network of Organ Sharing. DGF, defined as any dialysis in the first week of transplant, occurred in 141 recipients (32%). Alpha and pi-GST levels significantly increased during machine perfusion. The adjusted relative risks (95% confidence interval) of DGF with each log-unit increase in base and post pi-GST were 1.14 (1.0-1.28) and 1.33 (1.02-1.72), respectively. Alpha-GST was not independently associated with DGF. There were no significant differences in GST values between discarded and transplanted kidneys, though renal resistance was significantly higher in discarded kidneys. We found pi-GST at the end of machine perfusion to be independently associated with DGF. Further studies should elucidate the utility of GST for identifying injured kidneys with regard to organ allocation, discard and recipient management decisions.

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Machine perfusion viability testing

Cited by 30 publications

References 44 publications

Recommendations for donation after circulatory death kidney transplantation in Europe

Recommendations for donation after circulatory death kidney transplantation in Europe

Normothermic ex vivo kidney perfusion for graft quality assessment prior to transplantation

Glutathione S-Transferase Iso-Enzymes in Perfusate From Pumped Kidneys Are Associated With Delayed Graft Function

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