Peritoneal Cooling May Provide Improved Protection for Uncontrolled Donors After Cardiac Death: An Exploratory Porcine Study

Abstract

Uncontrolled donation after cardiac death (DCD) renal transplantation relies on rapid establishment of organ preservation interventions. We have developed a model of the uncontrolled DCD, comparing current in situ perfusion (ISP) techniques with additional peritoneal cooling (PC). Ten pigs were killed and subjected to a 2 h ischemia period. The ISP group modeled current DCD protocols. The PC group (PC) modeled current protocols plus PC. Two animals were used as controls and subjected to 2 h of warm ischemia. Core renal temperature and microdialysis markers of ischemia were measured. Preservation interventions began at 30 min, with rapid laparotomy and kidney recovery performed at 2 h, prior to machine perfusion viability testing. The final mean renal temperature achieved in the ISP group was 26.3• C versus 16.9• C in the PC group (p = 0.0001). A significant cryopreservation benefit was suggested by lower peak microdialysate lactate and glycerol levels (ISP vs. PC, p = 0.0003 and 0.0008), and the superiority of the PC group viability criteria (p = 0.0147). This pilot study has demonstrated significant temperature, ischemia protection and viability assessment benefits with the use of supplementary PC. The data suggests a need for further research to determine the potential for reductions in the rates of ischemia-related clinical phenomena for uncontrolled DCDs.

Recommendations for donation after circulatory death kidney transplantation in Europe

“…It has been used in donors with ISP before laparotomy using two catheters to flush and drain the peritoneal cavity . In an animal study, the renal temperature was significantly lower with TC in addition to normal cold intravascular flush . Immersing the cooling coil in subzero fluids gave a faster decrease in the intraperitoneal temperature with reduction in DGF .…”

Beyond Poiseuille: Preservation Fluid Flow in an Experimental Model

“…Preservation fluid pressure appears to influence graft function [12–17], but it is also likely that fluid flow rate is clinically important, as heat transfer, and therefore organ cooling, is flow-dependent [18], and rapid organ cooling has been shown to improve cellular and organ viability [19, 20]. These two variables are interrelated, and many clinicians would assume that Poiseuille's equation adequately describes this relationship.…”