Methods of Reduction of Warm Ischemic Time in Kidney Transplantation and Their Role of Early and Late Outcomes

Abstract

Kidney is the organ transplanted most often. An increase in the number of expanded criteria donors (ECD) has been observed for years, and consequently the condition of transplanted organs worsened. In recent years, the possibility to recover organs from donors after cardiac death (DCD) became legally available in Poland, which will result in the increase of donors. Every DCD donor is at the same time ECD donor. One of the most important challenges the transplantology has to face is the improvement of the quality of transplanted organs. In this study the available data on the reduction of warm ischemic time (WIT) on transplanted kidney has been presented. WIT may influence early and late outcome of kidney allograft. Long WIT increases the risk of delayed graft function (DGF). DGF occurs more often in transplanted kidneys from DCD. One of the main reasons for that is the fact that DCD have longer WIT compared to donors after brain death (DBD). So-called WIT II appearing during vascular anastomosis in kidney transplantation may be reduced by various techniques. The model of clear sterilized polyethylene bag developed by the authors has been presented. The construction of the bag, consisting of three compartments, allow to safely perform vascular anastomosis while keeping the temperature of the transplanted kidney low. The article describes as well other techniques used to decrease WIT II. The effect of anastomosis time on allograft outcome is still not well researched. The article presents the newest information regarding the influence of WIT on graft and patient survival.

Pharmacological Protection of Kidney Grafts from Cold Perfusion-Induced Injury

“…WIT II relates to vascular anastomosis (from removal of the organ from ice until reperfusion in recipient) [14] and this type of injury may be reduced by faster anastomosis or keeping the kidney cool during anastomosis using Ice Bag Technique [14].…”

A Novel Cooling Device for Kidney Transplant Surgery

“…2,12,20,22,23 Ice bag immersion techniques generally involve suspending the kidney in a bag containing ice slush, cold saline, and/or other cold preservation solutions. 12,18,[24][25][26][27][28][29][30] Unlike cooling irrigation, sufficient renal cooling has been reported with some of these methods (median cortical and medullary temperatures of 4°C and 5°C after 30 minutes of WIT, respectively). [24][25][26] However, clinical adoption remains very limited, likely because these methods are bulky, clumsy and obscure the surgeon's view during anastomosis.…”