Outcome of machine-perfused non-heart-beating donor kidneys, not allocated within the Eurotransplant area

Kievit, J.K.; Nederstigt, A. P.; Oomen, A.P.A.; Rizvi, Syed Adibul Hasan; Naqvi, Anwar; Thiel, G; Meester, Johan De; Kootstra, G.

doi:10.1007/s001470050513

Cited by 7 publications

(4 citation statements)

References 16 publications

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“…MP may reduce the DGF of grafts retrieved from heart-beating donors and donation after cardiac death (DCD) donors by 20% (7)(8)(9)(10)(11)(12)(13)(14)(15)(16). Many authors have reported on the beneficial effects of MP on organs from marginal and DCD donors (33)(34)(35)(36)(37). Reports on renal allograft function in relation to preservation mode have focused on observations up to 12 months post-transplant (38)(39)(40)(41)(42) or have applied statistical simulation based on the relationship between function and graft survival and DGF (43)(44)(45)(46)(47) or the relationship between DGF and acute rejection (48).…”

Section: Discussionmentioning

confidence: 99%

Machine Perfusion Preservation Improves Renal Allograft Survival

Kwiatkowski

Wszoła

Kosieradzki

et al. 2007

American Journal of Transplantation

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Machine perfusion (MP) has been used as the kidney preservation method in our center for over 10 years. The first, small (n = 74) prospective, single-blinded randomized study comparing MP and Cold Storage (CS) showed that the incidence of delayed graft function was higher after CS. There have been no reports in the literature on the effect of storage modality on longterm function of renal allografts. This paper presents an analysis of long-term results of renal transplantation in 415 patients operated on between 1994 and 1999. Of those, 227 kidneys were MP-stored prior to KTx. The control group consisted of 188 CS kidney transplants. Kidneys were not randomized to MP or to CS. Donor demographics, medical and biochemical data, cold ischemia time, HLA match and recipient data were collected. Standard triple-drug immunosuppression was administered to both groups. Mortality, graft survival and incidence of return to hemodialysis treatment were analyzed. Despite longer cold ischemia time and poorer donor hemodynamics in MP group, 5-year Kaplan-Meier graft survival was better in MP-stored than in CS-stored kidneys (68.2% vs. 54.2%, p = 0.02). Conclusion: In this nonrandomized analysis, kidney storage by MP improved graft survival and reduced the number of patients who returned to dialysis.

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Section: Discussionmentioning

confidence: 99%

Machine Perfusion Preservation Improves Renal Allograft Survival

Kwiatkowski

Wszoła

Kosieradzki

et al. 2007

American Journal of Transplantation

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“…Donor clinic played an important role to publicize donor well being which resulted in decreasing the refusal rates in the family from 60% in 1980s to <15% in 2009. International recognition of the institute led to the first deceased donor transplant in the country in 1994, courtesy Eurotransplant Foundation (7) and thus far, we have transplanted 26 kidneys from Europe. These played an important role in bringing awareness about deceased organ donation in the country (8). The country's first local heart beating deceased donor transplant was performed at the institute in 1998.…”

Section: Dialysis and Transplantation At The Institutementioning

confidence: 99%

A Renal Transplantation Model for Developing Countries

Rizvi

Naqvi

Zafar

et al. 2011

American Journal of Transplantation

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The estimated incidence of end-stage renal disease (ESRD) in Pakistan is 100 per million population. Paucity and high costs of renal replacement therapy allows only 10% to get dialysis and 4-5% transplants. Our center, a government organization, started a dialysis and transplant program in 1980s where all services were provided free of charge to all patients. It was based on the concept of community government partnership funded by both partners. The guiding principles were equity, transparency, accountability and development of all facilities under one roof. This partnership has sustained itself for 30 years with an annual budget of $25 million in 2009. Daily 600 patients are dialyzed and weekly 10-12 receive transplants. Oneand 5-year graft survival of 3000 transplants is 92% and 85%, respectively. The institute became a focus of transplantation in Pakistan and played a vital role in the campaign against transplant tourism and in promulgation of transplant law of 2007, and also helped to increase altruistic transplants in the country. This model emphasizes that in developing countries specialized centers in government sector are necessary for transplantation to progress and community support can make it available to the common man.

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“…The key benefits are a reduction in preservation injury and improved ability to withstand prolonged ischemia with preserved hepatocellular function 63,64 . Similar techniques have been used with success in clinical transplantation involving other organs, with promising results 65–69 . Experimental studies on liver have shown that extracorporeal perfusion has the ability to ‘recondition’ the marginal liver grafts that have undergone warm ischemic injury during NHBD procurement, and in those with steatosis 64,70–73 .…”

Section: Future Of Liver Transplantationmentioning

confidence: 99%

Liver transplantation: Issues for the next 20 years

Perera

Mirza

Elias

2009

J of Gastro and Hepatol

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The growing numbers of potential transplant recipients on waiting lists is increasingly disproportionate to the supply of cadaveric donor organs. The hope for the next 20 years is that supply will satisfy demand. This requires both a reduction in indications for the procedure and an increase in the transplants performed. A multi-pronged approach is needed to increase cadaveric organ donation, generating enthusiasm for donation among both the general public and hospital staff. Accurate assessment of marginal grafts with stringent criteria known to predict graft function will diminish wastage of organs. Methods of rehabilitating marginal grafts during extracorporeal perfusion will increase organ availability. Supply of non-heart beating donors can be greatly expanded and protocols developed with ethical consent to optimize their initial function despite warm ischemia. Splitting livers that fulfill selection criteria, thus providing for two recipients, should be universally applied with acceptable incentives to those units who do not directly benefit. A proportion of recipients, though not those transplanted for autoimmune disease, will be spared the side-effects of immunosuppression thanks to immune tolerance. Protocols for close monitoring of those patients for rejection during treatment withdrawal must be carefully observed. In addition to gene therapy, it is highly likely that hepatocyte transplantation will replace orthotopic grafting in patients without cirrhosis, especially for inherited metabolic diseases. It is much more difficult to envisage that heterologous stem cell transplantation or xenotransplantation will have clinical impact in the next 20 years, although research in those areas has obvious long-term potential.

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Outcome of machine-perfused non-heart-beating donor kidneys, not allocated within the Eurotransplant area

Abstract: We claim that MP can successfully assess viability of NHB donor kidneys. The reluctance to accept MP, and judged vital, NHB donor kidneys is not longer justified.

Cited by 7 publications

References 16 publications

Machine Perfusion Preservation Improves Renal Allograft Survival

Machine Perfusion Preservation Improves Renal Allograft Survival

A Renal Transplantation Model for Developing Countries

Liver transplantation: Issues for the next 20 years

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