Novel Organ Perfusion and Preservation Strategies in Transplantation – Where Are We Going in the United Kingdom?

O’Neill, Stephen; Srinivasa, Sanket; Callaghan, Chris; Watson, Christopher J.; Dark, John H.; Fisher, Andrew J.; Friend, Peter J.; Johnson, Rachel; Forsythe, John; Ploeg, Rutger J.; Mirza, Darius F.; Wigmore, Stephen J.; Oniscu, Gabriel C.

doi:10.1097/tp.0000000000003106

Cited by 34 publications

(29 citation statements)

References 110 publications

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“…Efforts could go to the optimization of kidney function and patient survival for transplant recipients with a high degree of aorto-iliac calcification. The kidney function of grafts from older donors may be improved, by decreasing cold ischemia time, reducing kidney rewarming during transplantation, and optimizing the use of hypothermic and normothermic machine perfusion [ 30 , 31 , 32 , 33 ]. To improve patient survival in general and death with a functioning graft specially, focus might go to the reduction of modifiable risk factors for cardiovascular disease in kidney transplant candidates and recipients.…”

Section: Discussionmentioning

confidence: 99%

Aorto-Iliac Artery Calcification and Graft Outcomes in Kidney Transplant Recipients

Benjamens

Alghamdi

Rijkse

et al. 2021

JCM

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While the association of vascular calcification with inferior patient outcomes in kidney transplant recipients is well-established, the association with graft outcomes has received less attention. With this dual-centre cohort study, we aimed to determine the clinical impact of recipient pre-transplant aorto-iliac calcification, measured on non-contrast enhanced computed tomography (CT)-imaging within three years prior to transplantation (2005–2018). We included 547 patients (61.4% male, age 60 (interquartile range 51–68) years), with a median follow-up of 3.1 (1.4–5.2) years after transplantation. The aorto-iliac calcification score (CaScore) was inversely associated with one-year estimated-glomerular filtration rate (eGFR) in univariate linear regression analysis (standard β −3.3 (95% CI −5.1 to −1.5, p < 0.0001), but not after adjustment for potential confounders, including donor and recipient age (p = 0.077). In multivariable Cox regression analyses, a high CaScore was associated with overall graft failure (p = 0.004) and death with a functioning graft (p = 0.002), but not with death-censored graft failure and graft function decline. This study demonstrated that pre-transplant aorto-iliac calcification is associated with one-year eGFR in univariate, but not in multivariable linear regression analyses. Moreover, this study underlines that transplantation in patients with a high CaScore does not result in earlier transplant function decline or worse death censored graft survival, although ongoing efforts for the prevention of death with a functioning graft remain essential.

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Section: Discussionmentioning

confidence: 99%

Aorto-Iliac Artery Calcification and Graft Outcomes in Kidney Transplant Recipients

Benjamens

Alghamdi

Rijkse

et al. 2021

JCM

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“…Organ preservation and re‐conditioning using machine perfusion technologies continue to generate promising results in terms of viability assessment, organ utilization and improved initial graft function [103,104]. Both hypothermic and normothermic machine perfusion have been used to assess and resuscitate organs that would otherwise have been discarded.…”

Section: Opportunities For Improving Organ Utilizationmentioning

confidence: 99%

Organ utilization – the next hurdle in transplantation?

Neuberger

Callaghan

2020

Transpl. Int.

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Summary Nonutilization of organs from consented deceased donors remains a significant factor in limiting patient access to transplantation. Critical to reducing waste is a clear understanding of why organs are not used: accurate metrics are essential to identify the extent and causes of waste but use of these measures as targets or comparators between units/jurisdictions must be done with caution as focus on any one measure may result in unintended adverse consequences. Comparison between centres or countries may be misleading because of variation in definitions, patient or graft characteristics. Two of the most challenging areas to improve appropriate deceased donor organ utilization are appetite for risk and lack of validated tools to help identify an organ that will function appropriately. Currently, the implanting surgeon is widely considered to be accountable for the use of a donated organ so guidelines must be clear to allow and support sensible decisions and recognition that graft failure or inadvertent disease transmission are not necessarily attributable to poor decision‐making. Accepting an organ involves balancing risk and benefit for the potential recipient. Novel technologies such as machine perfusion may allow for more robust guidance as to the functioning of the organ.

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“…As a result of this shortfall, higher risk organs such as those originating from expanded criteria donors (ECD) of brain death donors (DBD) or donated after circulatory death (DCD) are nowadays more frequently utilized. These kidneys are more susceptible to ischemia-reperfusion injury (IRI), which results in higher risk of delayed graft function (DGF), primary nonfunction (PNF), and graft failure [2][3][4][5]. The damage to the podocytes in the tubulus, also known as acute tubular necrosis, mainly caused by IRI, is considered the main cause of DGF after transplantation [6].…”

Section: Introductionmentioning

confidence: 99%

Simply Adding Oxygen during Hypothermic Machine Perfusion to Combat the Negative Effects of Ischemia-Reperfusion Injury: Fundamentals and Current Evidence for Kidneys

2021

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The use of high-risk renal grafts for transplantation requires optimization of pretransplant preservation and assessment strategies to improve clinical outcomes as well as to decrease organ discard rate. With oxygenation proposed as a resuscitative measure during hypothermic machine preservation, this review provides a critical overview of the fundamentals of active oxygenation during hypothermic machine perfusion, as well as the current preclinical and clinical evidence and suggests different strategies for clinical implementation.

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Novel Organ Perfusion and Preservation Strategies in Transplantation – Where Are We Going in the United Kingdom?

Cited by 34 publications

References 110 publications

Aorto-Iliac Artery Calcification and Graft Outcomes in Kidney Transplant Recipients

Aorto-Iliac Artery Calcification and Graft Outcomes in Kidney Transplant Recipients

Organ utilization – the next hurdle in transplantation?

Simply Adding Oxygen during Hypothermic Machine Perfusion to Combat the Negative Effects of Ischemia-Reperfusion Injury: Fundamentals and Current Evidence for Kidneys

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