Microbial Contamination During Kidney Ex Vivo Normothermic Perfusion

Phillips, Benedict L.; Chandak, Pankaj; Uwechue, Raphael; Pannerden, Claire van Nispen tot; Hemsley, Caroline; Callaghan, Chris

doi:10.1097/tp.0000000000002076

Cited by 13 publications

(15 citation statements)

References 6 publications

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“…A recent clinical study found that 56% of kidneys undergoing NMP had positive bacterial growth of Staphylococcal origin. None of the NMP perfusate‐cultured organisms were implicated in episodes of infection in the recipients 26 . Broad‐spectrum antibiotics such as Cefuroxime or Augmentin can be added during NMP 4,20,27 .…”

Section: Normothermic Machine Perfusion Protocolsmentioning

confidence: 99%

Normothermic kidney perfusion: An overview of protocols and strategies

Elliott

Nicholson

Hosgood

2021

American Journal of Transplantation

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Normothermic machine perfusion (NMP) technologies are emerging as an important adjunct in organ preservation and transplantation. NMP can enable the reduction or avoidance of cold ischemia and allows for pretransplant measurement of function and metabolic status to assess the suitability of the organ for transplantation. The key requirement of NMP is to provide an environment that is protective to the organ, ensures optimal oxygen delivery and supports metabolic function. Red blood cell‐based solutions, artificial hemoglobin solutions, and acellular solutions have all been utilized in NMP. However, there is no clear consensus on perfusion protocols. A period of NMP after hypothermic preservation is the most commonly used strategy. As an alternative, several groups have developed and tested the feasibility of more prolonged periods of NMP. There are only a few reports of the application of NMP in clinical kidney transplantation and each uses different approach and conditions. This review details the rationale for NMP protocols considering duration of NMP and different perfusate compositions in experimental and clinical models. We also include a discussion on the mechanistic action of NMP, comparison of subnormothermic and hypothermic conditions, the different logistical approaches and future requirements.

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Section: Normothermic Machine Perfusion Protocolsmentioning

confidence: 99%

Normothermic kidney perfusion: An overview of protocols and strategies

Elliott

Nicholson

Hosgood

2021

American Journal of Transplantation

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“…The safety of EVNP will continue to be monitored. A previous study has shown that a significant proportion of cultures taken from warm perfusate during EVNP grew bacteria, though these are of doubtful clinical significance . Given uncertainties about appropriate doses, and the underlying rationale, antibiotics are not given during EVNP.…”

Section: Discussionmentioning

confidence: 99%

“…At the hospital level, both new centers obtained local clinical governance approval for the use of EVNP via novel procedures committees. For both centers, advice was sought from local hospital departments including hematology (to approve the use of packed red blood cells from the blood bank), microbiology (to assess the risk of potential infection of the kidney during EVNP), medical physics (to test and approve EVNP equipment), and operating theater and anesthetic staff (to provide the environment for clinical EVNP).…”

Section: Methodsmentioning

confidence: 99%

Dissemination of a novel organ perfusion technique: ex vivo normothermic perfusion of deceased donor kidneys

et al. 2019

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Ex vivo normothermic perfusion (EVNP) technology is a promising means of organ preservation, assessment, and preconditioning prior to kidney transplantation, which has been pioneered by a single group. We describe the challenges of setting up clinical EVNP programs in 2 new centers, as well as early patient outcomes. Governance, training, and logistical pathways are described. In order to demonstrate safety and proficiency in this new technique, early patient outcomes are also described. Patient outcomes included the incidence of primary nonfunction, delayed graft function, graft and patient survival at 1 year. Contralateral kidneys undergoing static cold storage alone were used as a comparator group. Between March 2016 and July 2017, EVNP was performed on 14 kidneys from 12 donors (11 kidneys in center 1, 3 kidneys in center 2). Of the 14 kidneys that underwent EVNP, 12 organs were implanted into 10 recipients. Two pairs of kidneys were implanted as dual grafts and 1 kidney was implanted simultaneously with a pancreas. The remaining 7 kidneys were transplanted as single allografts. Seven pairs of kidneys were available for paired analysis comparing EVNP versus static cold storage. Graft and patient outcomes were comparable between the 2 preservation techniques. The introduction of a clinical EVNP service requires a careful multimodal approach, drawing on the expertise of specialists in transplantation, hematology, and microbiology. Both new clinical EVNP programs demonstrated proficiency and safety when a structured dissemination process was followed.

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“…NMP may provide an opportunity to minimise this. The use of antibiotics during NMP of the liver is well established and has been a part of our group's clinical protocol [12]; however, this not true of all organs, for example, the kidney [11], where no antimicrobial therapies given during perfusion and infective complications have been reported [53].…”

Section: Microbial Transmissionmentioning

confidence: 99%

Normothermic Machine Perfusion (NMP) of the Liver as a Platform for Therapeutic Interventions during Ex-Vivo Liver Preservation: A Review

Dengu

Abbas

Ebeling

et al. 2020

JCM

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Liver transplantation is increasingly dependent on the use of extended criteria donors (ECD) to increase the organ donor pool and address rising demand. This has necessitated the adoption of innovative technologies and strategies to protect these higher-risk grafts from the deleterious effects of traditional preservation and ischaemia reperfusion injury (IRI). The advent of normothermic machine perfusion (NMP) and rapid growth in the clinical adoption of this technology has accelerated efforts to utilise NMP as a platform for therapeutic intervention to optimise donor livers. In this review we will explore the emerging preclinical data related to ameliorating the effects of IRI, protecting the microcirculation and reducing the immunogenicity of donor organs during NMP. Exploiting the window of opportunity afforded by NMP, whereby the liver can be continuously supported and functionally assessed while therapies are directly delivered during the preservation period, has clear logistical and theoretical advantages over current preservation methods. The clinical translation of many of the therapeutic agents and strategies we will describe is becoming more feasible with widespread adaptation of NMP devices and rapid advances in molecular biology and gene therapy, which have substantially improved the performance of these agents. The delivery of novel therapeutics during NMP represents one of the new frontiers in transplantation research and offers real potential for successfully tackling fundamental challenges in transplantation such as IRI.

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Microbial Contamination During Kidney Ex Vivo Normothermic Perfusion

Cited by 13 publications

References 6 publications

Normothermic kidney perfusion: An overview of protocols and strategies

Normothermic kidney perfusion: An overview of protocols and strategies

Dissemination of a novel organ perfusion technique: ex vivo normothermic perfusion of deceased donor kidneys

Normothermic Machine Perfusion (NMP) of the Liver as a Platform for Therapeutic Interventions during Ex-Vivo Liver Preservation: A Review

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