Normothermic Ex Vivo Kidney Perfusion Following Static Cold Storage—Brief, Intermediate, or Prolonged Perfusion for Optimal Renal Graft Reconditioning?

Abstract

Normothermic ex vivo kidney perfusion (NEVKP) demonstrated superior results compared to hypothermic storage in donation after circulatory death (DCD) kidney transplantation. It is unknown whether an optimal perfusion time exists following hypothermic storage to allow for the recovery of renal grafts from cold ischemic injury. In a porcine model of DCD kidney autotransplantation, the impact of initial static cold storage (SCS) (8 h) followed by various periods of NEVKP recovery was investigated: group A, 8 hSCS only (control); group B, 8 hSCS + 1 hNEVKP (brief NEVKP); group C, 8 hSCS + 8 hNEVKP (intermediate NEVKP); and group D, 8 hSCS + 16 hNEVKP (prolonged NEVKP). All grafts were preserved and transplanted successfully. One animal in group D was sacrificed and excluded by postoperative day 3 due to hind limb paralysis, but demonstrated good renal function. Postoperative graft assessment during 8 days’ follow‐up demonstrated lowest levels of peak serum creatinine for intermediate (C) and prolonged (D) NEVKP (p = 0.027). Histological assessment on day 8 demonstrated a significant difference in tubular injury (p = 0.001), with highest values for group B. These results suggest that longer periods of NEVKP following SCS are feasible and safe for postponing surgical transplant procedure and superior to brief NEVKP, reducing the damage caused during cold ischemic storage of renal grafts.

Extra‐corporeal normothermic machine perfusion of the porcine kidney: working towards future utilization in Australasia

“…One hour of NMP was chosen for this pilot study, although there is evidence that continuous/prolonged NMP may be more advantageous than the 1‐h perfusion period . The primary reason for this is the clinical applicability and potential for translation if 1–3 h of NMP is utilized – this can be performed at the recipient centre during the period in which the patient is being prepared for surgery.…”

Kidney Perfusion as an Organ Quality Assessment Tool—Are We Counting Our Chickens Before They Have Hatched?

“…The same group showed that kidney assessment during warm perfusion might lead to transplantation of initially discarded DCD kidneys [49]. Extending normothermic perfusion to longer periods (2 to 8 hours) has been explored in pig studies [50][51][52][53][54]. Kidneys not suitable for transplantation have been normothermically perfused for 24 hours, making use of urine recirculation, though not transplanted [55].…”

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

“…Assessment during EVNP also enables the integrity of the vascular repair to be examined. Other novel indications for EVNP are under investigation, including its use in prolonged preservation, 35 manipulation of organ immunogenicity, [36][37][38][39] and delivery of pharmacological [40][41][42][43][44][45] or temperature-dependent interventions (eg, cellular therapies 46 ).…”