The Prognostic Value of Renal Resistance During Hypothermic Machine Perfusion of Deceased Donor Kidneys

Abstract

Vascular renal resistance (RR) during hypothermic machine perfusion (HMP) is frequently used in kidney graft quality assessment. However, the association between RR and outcome has never been prospectively validated. Prospectively collected RR values of 302 machine-perfused deceased donor kidneys of all types (standard and extended criteria donor kidneys and kidneys donated after cardiac death), transplanted without prior knowledge of these RR values, were studied. In this cohort, we determined the association between RR and delayed graft function (DGF) and 1-year graft survival. The RR (mmHg/mL/min) at the end of HMP was an independent risk factor for DGF (odds ratio 21.12 [1.03-435.0]; p = 0.048) but the predictive value of RR was low, reflected by a c-statistic of the receiver operator characteristic curve of 0.58. The RR was also found to be an independent risk factor for 1-year graft failure (hazard ratio 12.33 [1.11-136.85]; p = 0.004). Determinants of transplant outcome are multifactorial in nature and this study identifies RR as an additional parameter to take into account when evaluating graft quality and estimating the likelihood of successful outcome. However, RR as a stand-alone quality assessment tool cannot be used to predict outcome with sufficient precision.

Mechanistic Analysis of Nonoxygenated Hypothermic Machine Perfusion’s Protection on Warm Ischemic Kidney Uncovers Greater eNOS Phosphorylation and Vasodilation

“…The observation of an inhibition of NO-dependent vasodilation after one rinse ex situ ensures that the dose used in the machine is sufficient to inhibit NOS activity during perfusion. Nevertheless, the presence of L-NAME in the machine did not alter the decrease in resistance index during perfusion observed in the present work and by others (20,(47)(48)(49). The absence of effect of L-NAME on the resistance index during MP suggests that this phenomenon is NO-independent.…”

Ex Vivo Perfusion Characteristics of Donation After Cardiac Death Kidneys Predict Long-Term Graft Survival

“…Similar to our study, Vries et al also found that renovascular resistance during machine perfusion did not relate to graft and patient survival [27]. In contrast, Jochmans et al has found that RT was an independent risk factor for delayed graft function and 1-year graft failure [28]. Patients in the medium GST group had worse graft survival and similar eGFR values compared to low and high groups.…”

Identifying Potential Kidney Donors Among Newborns Undergoing Circulatory Determination of Death

“…Placing donor kidneys after procurement on a specialized external "pump" permits evaluation of vascular resistance flow, as well as organ viability by evaluating urine production. 23 It also notably improves outcomes by decreasing the prevalence of delayed graft function. 24,25 Because prolonged cold ischemic time (up to 48 hours) is widely accepted, en bloc kidneys procured from donor newborns can be transported easily to specialized centers willing to transplant these small organs.…”