Should Pulsatile Preservation Be the Gold Standard in Kidney Transplantation?

Abstract

In recent years, dramatic improvements in kidney transplantation, together with a rising incidence of diseases such as diabetes, have led to an increasing demand for deceased donor kidneys for transplantation. Hence, it has been necessary to expand the kidney donor pool by using organs once considered unsuitable for transplantation. These higher risk kidneys are typically from older donors with additional comorbidities and are more susceptible to injury. Therefore, the transplant community has been focusing efforts in trying to improve the outcomes of these high-risk organs. Preservation by pulsatile machine perfusion has been associated with decreased risk of delayed graft function and renoprotective effects on deceased donor kidneys. The aim of this review is to provide an overview of the principles of this preservation technique and to review the evidence regarding its usage for deceased donor kidneys compared to standard static cold storage.

Overcoming the longest cold ischemia time yet seen in Korea using hypothermic machine perfusion in deceased donor kidney transplantation: a case report

“…HMP involves a system that delivers cold perfusate, supplying nutrients and oxygen through extracorporeal circulation. This process also prevents the accumulation of toxic metabolic byproducts that are closely associated with organ apoptosis, while improving graft function compared to traditional SCS [ 7 , 8 ]. Technological advancements have led to the development of HMP devices that are compact enough to be carried by a single individual during organ transport [ 9 ].…”

Comparison of nighttime and daytime operation on outcomes of kidney transplant with deceased donors

“…[12] HMP has been confirmed to have advantages such as offering nutrients, washing out byproducts and micro-thrombosis, and assessing graft viability according to machine parameters, which reduce DGF, AR and primary non-function. [35–40] In our center, HMP is applied to 78.78% of patients, which may be another reason to explain the low incidence of DGF. Although older donors with higher BMI had increased risk of DGF in the daytime group, HMP with protective effect on grafts was applied more in the daytime group, leading to explainable results of DGF and AR between the daytime and nighttime groups [Tables 4 and 5].…”

Strategies for organ preservation: Current prospective and challenges

“…as NO donor and CORM-3 as CO-releasing molecule during NMP was demonstrated to result in improved glomerular function in pigs (Hosgood et al, 2008). In particular, Kruppel-like factor 2 (KLF2) T A B L E 2 Components of preservation solutions and their functions appears to inhibit pro-inflammatory responses and the production of vasodilators such as endothelial NO and mediates the expression of antithrombogenic genes such as thrombomodulin (Lin et al, 2005;Lo Faro et al, 2015;Yuan et al, 2010). There are many advantages of using NMP over other contemporary organ-preservation methods (Figure 6a).…”