Organ storage in renal transplantation

Abstract

Purpose of review Kidney transplantation is vital for those with end-stage renal disease, enhancing quality of life and longevity. It is the preferred treatment but is hindered by a global disparity between donor kidney availability and demand. Therefore, optimizing organ storage techniques is crucial to mitigate the effects of ischemia reperfusion injury in available organs. Recent interest has centered on innovative methods like oxygenated normothermic perfusion and abdominal regional perfusion. Recent findings Multiple recent metanalyses, including a Cochrane review, confirm the benefits of hypothermic machine perfusion (HMP) for deceased donor kidneys, demonstrating its utility and cost effectiveness. The benefits of oxygenated normothermic perfusion have been seen in retrospective data sets but not in prospective trials. Abdominal regional perfusion (aNRP) is gaining interest, especially for liver transplantation, but kidney specific data are scant. Summary High-quality evidence backs the use of HMP for deceased donor kidneys. Despite interest in other techniques, clinical evidence for their benefits in kidney transplantation is lacking. The gap between innovation and verified success emphasizes the need for continued research and collaboration between medical professionals, researchers, and ethical committees. This review aims to further illuminate the complexities and advancements in the field, bridging the knowledge gap and aiding in the continual pursuit of excellence in transplantation.

The Puzzle of Preimplantation Kidney Biopsy Decision-Making Process: The Pathologist Perspective

“…Different kinds of liquids are available nowadays as long as pulsatile systems and temperature-regulating machines keep the harvested organs in solutions closely resembling its physiological conditions. Some advantages of perfusion machines are: extended preservation time (this is essential for organs that need to be transported over longer distances or when there is a delay between organ retrieval and transplantation), improved organ viability (perfusion with a preservation solution helps to maintain optimal oxygenation and nutrient supply to the organ), organ evaluation/assessment (functional parameters can be monitored during perfusion), treatment of ischemia-reperfusion injury (allowing for interventions during the perfusion process to mitigate ischemia-reperfusion injury, enhancing the organ's post-transplant performance), and improving transplantation from marginal donors (improving the condition of these organs and making them more suitable for transplantation) [49][50][51]. In detail, compared to SCS, machine-perfused kidneys have revealed significantly lower rates of delayed graft function (DGF) and, overall, reduced transplant-related costs.…”