Protection From the Second Warm Ischemic Injury in Kidney Transplantation Using an Ex Vivo Porcine Model and Thermally Insulating Jackets

Khan, Turaab; Kwarcinski, Jeremy; Pang, Tony; Hameed, Ahmer; Boughton, Philip; O’Grady, Greg; Hawthorne, Wayne J.; Rogers, Natasha M.; Wong, Germaine; Pleass, Henry

doi:10.1016/j.transproceed.2021.01.037

Cited by 7 publications

(13 citation statements)

References 28 publications

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“…Along with a reduction in warm ischemia experienced, KPJ™ also potentially provides the surgical team with additional time to perform the surgery, potentially reducing the risk of surgical complications due to time pressure. 8,10,12 Furthermore, this has the capacity to improve surgical training and open the door to robotic transplantation techniques, which typically are associated with prolonged surgical times during the learning curve. 16 This together, improved thermal regulation and reduced surgical time pressure equates to improved patient outcomes, reduced surgical complications due to time pressure, and significant health economic savings.…”

Section: Discussionmentioning

confidence: 99%

“…Additional ice was also utilized when necessary to ensure the temperature of the back table ice tray would be regulated at 0-4°C, similar to back table temperatures observed in literature. 9,10 To simulate organ warming during transplantation, an ex vivo transplantation model using a water bath regulated at 37°C to replicate average human body temperature was used. This ex vivo model has been described previously.…”

Section: Water Bath Experimental Modelmentioning

confidence: 99%

“…The time to reach the metabolic threshold was prolonged by KPJ™ from 17.2 min to 35.2 min. 10 Such a device has not been tested on human kidneys.…”

Section: Introductionmentioning

confidence: 99%

“…2,[4][5][6][7][8] The metabolic threshold temperature at which warm ischemia occurs is between 15-18°C and therefore maintaining kidney temperature below this threshold could prove beneficial in reducing second warm ischemia. 2,[9][10][11][12][13][14][15][16] There is currently no effective and commercially available medical device that seeks to intraoperatively reduce the warm ischemia experienced by the kidney during transplantation. The authors have developed an insulating jacket (KPJ™) designed to fit all adult sized kidneys and have demonstrated thermal protective effects using porcine kidneys in an ex vivo water bath model.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, a reduction in the total warm ischemic injury experienced by the kidney would potentially be valuable 2,4–8 . The metabolic threshold temperature at which warm ischemia occurs is between 15–18°C and therefore maintaining kidney temperature below this threshold could prove beneficial in reducing second warm ischemia 2,9–16 …”

Section: Introductionmentioning

confidence: 99%

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Insulating jackets thermally protect kidneys in an ex vivo model of second warm ischemia

et al. 2022

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Background Kidney transplantation is the current optimal treatment for suitable patients with end‐stage renal disease. The second warm ischemic time (SWIT) is known to negatively impact delayed graft function, and long‐term graft survival, and methods are required to ameliorate the impacts of SWIT on transplantation outcomes. Materials and Methods This study primarily focused on determining the effect of a novel thermally insulating jacket on the thermal profile of the human kidney and quantifying the reduction in thermal energy experienced using this device (KPJ™). An ex vivo simulated transplantation model was developed to determine the thermal profiles of non‐utilized human kidneys with and without KPJ™ (n = 5). Control kidney temperature profiles were validated against the temperature profiles of n = 10 kidneys during clinical kidney transplantation. Results Using the ex‐vivo water bath model, the thermally insulated human kidney reached the 15°C metabolic threshold temperature at 44.5 ± 1.9 min (vs control: 17.3 ± 1.8 min (p = 0.00172)) and remained within the 18°C threshold until 53.3 ± 1.3 min (vs control: 20.9 ± 2.0 min (p = 0.002)). The specific heat capacity of KPJ™ protected kidney was four‐fold compared to the control kidney. The clinical temperature audit, closely correlated with the water bath model, hence validating this ex‐vivo human kidney transplant model. Conclusion Intraoperative thermal protection is a simple and viable method of reducing the thermal injury that occurs during the SWIT and increasing the specific heat capacity of the system. Such technology could easily be translated into clinical kidney transplant practice.

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