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Machine perfusion kidney

D Dondossola, C Lonati, A Zanella, M Maggioni, B Antonelli, P Reggiani, S Gatti, G Rossi
BACKGROUND: Machine perfusion is increasingly utilized in liver transplantation to face the detrimental consequences of the use of extended-criteria donors. Hypothermic oxygenated machine perfusion (HOPE) appears to be more protective relative to static cold storage. Conversely, normothermic machine perfusion (NMP) allows a better graft evaluation. We describe a pilot prospective study on machine perfusion in selected grafts. METHODS: HOPE was executed for all the grafts procured from donors after cardiac death (DCDs) and for livers from donors after brain death (DBDs) requiring prolonged preservation time...
January 2019: Transplantation Proceedings
Guofeng Gao, Ling-Xin Chen, Ian E Brown, Angelo De Mattos, Richard V Perez, Kuang-Yu Jen
BACKGROUND: Limited data is available regarding whether donor kidneys with diffuse glomerular fibrin thrombi (GFT) are safe to use. In this study, the clincopathologic characteristics of allografts with diffuse donor-derived GFT were examined. METHODS: All deceased donor kidney transplant implantation biopsies from our institution between 07/2011 to 02/2018 with diffuse GFT were included. A control group for comparison consisted of all cases with implantation biopsies obtained during the study period without diffuse GFT...
January 30, 2019: Transplantation
D Nakladal, H Buikema, A Reyes Romero, S P H Lambooy, J Bouma, G Krenning, P Vogelaar, A C van der Graaf, M R Groves, J Kyselovic, R H Henning, L E Deelman
SUL-compounds are protectants from cold-induced ischemia and mitochondrial dysfunction. We discovered that adding SUL-121 to renal grafts during warm machine reperfusion elicits a rapid improvement in perfusion parameters. Therefore, we investigate the molecular mechanisms of action in porcine intrarenal arteries (PIRA). Porcine kidneys were stored on ice overnight and perfusion parameters were recorded during treatment with SUL-compounds. Agonist-induced vasoconstriction was measured in isolated PIRA after pre-incubation with SUL-compounds...
January 9, 2019: Scientific Reports
H Tedesco Silva, R W Evans, M B Gavaghan, V C Vazquez
The clinical benefit of machine perfusion (MP) was recently assessed in a 1-year Brazilian multicenter prospective randomized trial, that showed that the use of MP was associated with a reduced incidence of delayed graft function (DGF) compared to static cold storage (SCS) in kidney transplant recipients (45% vs 61%). The objective of the present analysis is to consider the cost-effectiveness of MP relative to SCS based on clinical data from this Brazilian cohort. A decision tree model was constructed to simulate a population of 1000 kidney transplant recipients based on data derived from this Brazilian multicenter clinical trial...
December 2018: Transplantation Proceedings
Thomas Minor, Charlotte von Horn, Andreas Paul
Short term normothermic reconditioning by machine perfusion after cold storage has shown beneficial effects in renal transplantation models. Systematic investigations concerning the inclusion of washed erythrocytes as oxygen carriers are lacking in this context. Porcine kidneys were subjected to 20h of static cold storage. Prior to reperfusion, grafts were put on a machine for 2h of oxygenated (95% O2 ; 5% CO2 ) rewarming perfusion. In one group (n=6) washed erythrocytes were added to the perfusate after temperature has reached 20°C; the other group (n=6) was run without additives...
December 4, 2018: Artificial Organs
José Ignacio Domínguez, Martin de Amesti, Alejandro Majerson
INTRODUCTION: The adequate preservation of the allograft prior to kidney transplant is key for a good outcome after transplantation. Currently, there are two main methods: hypothermic machine perfusion and static cold preservation. The main objective of this summary is to compare both preservation systems. METHODS: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others...
November 30, 2018: Medwave
Isaac E Hall, Enver Akalin, Jonathan S Bromberg, Mona D Doshi, Tom Greene, Meera N Harhay, Yaqi Jia, Sherry G Mansour, Sumit Mohan, Thangamani Muthukumar, Peter P Reese, Bernd Schröppel, Pooja Singh, Heather R Thiessen-Philbrook, Francis L Weng, Chirag R Parikh
Deceased-donor acute kidney injury (AKI) is associated with organ discard and delayed graft function, but data on longer-term allograft survival are limited. We performed a multicenter study to determine associations between donor AKI (from none to severe based on AKI Network stages) and all-cause graft failure, adjusting for donor, transplant, and recipient factors. We examined whether any of the following factors modified the relationship between donor AKI and graft survival: kidney donor profile index, cold ischemia time, donation after cardiac death, expanded-criteria donation, kidney machine perfusion, donor-recipient gender combinations, or delayed graft function...
November 14, 2018: Kidney International
Kamlesh Patel, Thomas B Smith, Desley Ah Neil, Alpesh Thakker, Yugo Tsuchiya, Ellen B Higgs, Nikolas J Hodges, Andrew R Ready, Jay Nath, Christian Ludwig
BACKGROUND: Supplemental oxygenation of the standard Hypothermic Machine Perfusion (HMP) circuit has the potential to invoke favourable changes in metabolism, optimising cadaveric organs prior to transplantation. METHODS: Eight pairs of porcine kidneys underwent 18 hours of either oxygenated (HMP/O2) or aerated (HMP/Air) HMP in a paired DCD model of transplantation. Circulating perfusion fluid was supplemented with the metabolic tracer universally labelled glucose ([U-C] glucose)...
November 19, 2018: Transplantation
Chen-Guang Ding, Pu-Xun Tian, Xiao-Ming Ding, He-Li Xiang, Yang Li, Xiao-Hui Tian, Feng Han, Qian-Hui Tai, Qian-Long Liu, Jin Zheng, Wu-Jun Xue
Background: Vascular resistance and flow rate during hypothermic machine perfusion (HMP) of kidneys is correlated with graft function. We aimed to determine the effects of increasing HMP pressure versus maintaining the initial pressure on kidney transplantation outcomes. Methods: We retrospectively reviewed the data of 76 primary transplantation patients who received HMP-preserved kidneys from 48 donors after cardiac death between September 1, 2013, and August 31, 2015...
November 20, 2018: Chinese Medical Journal
Chen-Guang Ding, Yang Li, Xiao-Hui Tian, Xiao-Jun Hu, Pu-Xu Tian, Xiao-Ming Ding, He-Li Xiang, Jin Zheng, Wu-Jun Xue
Background: Hypothermic machine perfusion (HMP) is being used more often in cardiac death kidney transplantation; however, the significance of assessing organ quality and predicting delayed graft function (DGF) by HMP parameters is still controversial. Therefore, we used a readily available HMP variable to design a scoring model that can identify the highest risk of DGF and provide the guidance and advice for organ allocation and DCD kidney assessment. Methods: From September 1, 2012 to August 31, 2016, 366 qualified kidneys were randomly assigned to the development and validation cohorts in a 2:1 distribution...
November 20, 2018: Chinese Medical Journal
Amir Sedigh, Sofia Nordling, Fredrik Carlsson, Erik Larsson, Bo Norlin, Norbert Lübenow, Fredrik Lennmyr, Gunnar Tufveson, Peetra U Magnusson, Tomas Lorant
BACKGROUND: Previously we have been able to demonstrate the possibility of coating the inner surface of the renal arteries in porcine kidneys with a heparin conjugate during hypothermic machine perfusion (HMP). The purpose of this study was to assess the efficacy of this treatment in reducing early ischemia-reperfusion injury. METHOD: Brain death was induced in male landrace pigs by stepwise volume expansion of an epidural balloon catheter until negative cerebral perfusion pressure was obtained...
October 6, 2018: Transplantation
J Branchereau, K Renaudin, Delphine Kervella, S Bernadet, Georges Karam, Gilles Blancho, D Cantarovich
BACKGROUND: There are currently two approaches to hypothermic preservation for most solid organs: static or dynamic. Cold storage is the main method used for static storage (SS), while hypothermic pulsatile perfusion (HPP) and other machine perfusion-based methods, such as normothermic machine perfusion and oxygen persufflation, are the methods used for dynamic preservation. HPP is currently approved for kidney transplantation. METHODS: We evaluated, for the first time, the feasibility of HPP on 11 human pancreases contraindicated for clinical transplantation because of advanced age and/or history of severe alcoholism and/or abnormal laboratory tests...
October 4, 2018: Cryobiology
Panxin Peng, Zhenshan Ding, Yuhui He, Jun Zhang, Xuming Wang, Zhihao Yang
BACKGROUND: Static cold storage (SCS) and hypothermic machine perfusion (HMP) are two primary options for renal allograft preservation. Compared with SCS, HMP decreased the incidence of delayed graft function (DGF) and protected graft function. However, more evidence is still needed to prove the advantages of the HMP. OBJECTIVE: In this study, the outcomes of kidney grafts from the two preservation methods were compared by conducting a systematic review and meta-analysis...
October 3, 2018: Artificial Organs
Heloise Cardinal, Florence Lamarche, Stéphanie Grondin, Pierre Marsolais, Anne-Marie Lagacé, Anatolie Duca, Martin Albert, Isabelle Houde, Anne Boucher, Mélanie Masse, Dana Baran, Josée Bouchard
Meeting donor management goals (DMGs) has been reported to decrease the incidence of delayed graft function (DGF) after kidney transplant, but whether this relationship is independent of cold machine perfusion is unclear. We aimed to determine whether meeting DMGs is associated with a reduced incidence of DGF, independent of the use of machine perfusion. We collected data on consecutive brain-dead donors and their KT recipients (KTRs) between June 2013 and December 2016 in 5 adult transplant centers. We evaluated whether DMGs were met at donor neurologic death (DND) and later time points...
January 2019: American Journal of Transplantation
Wenke Markgraf, Philipp Feistel, Christine Thiele, Hagen Malberg
The lack of donor grafts is a severe problem in transplantation medicine. Hence, the improved preservation of existing and the usage of organs that were deemed untransplantable is as urgent as ever. The development of novel preservation techniques has come into focus. A promising alternative to traditional cold storage is normothermic machine perfusion (NMP), which provides the benefit of improving the organs' viability and of assessing the organs' status under physiological conditions. For this purpose, methods for evaluating organ parameters have yet to be developed...
October 25, 2018: Biomedizinische Technik. Biomedical Engineering
Alexandr Reznik, Olga Plotnikova, Andrey Skvortsov, Mikhail Skoblov, Oleg Reznik, Ancha Baranova
Utilization of kidneys from extended criteria donors leads to an increase in average warm ischemia time (WIT), which is associated with larger degrees of ischemia-reperfusion injury (IRI). Kidney resuscitation by extracorporeal perfusion in situ allows up to 60 minutes of asystole after the circulatory death. Molecular studies of kidney grafts from human donors with critically expanded WIT are warranted. Transcriptomes of two human kidneys from two different donors were profiled after 35-45 minutes of WIT and after 120 minutes of normothermic perfusion and compared...
2018: BioMed Research International
Tom Darius, Pierre Gianello, Martial Vergauwen, Nizar Mourad, Antoine Buemi, Martine De Meyer, Michel Mourad
The aims of this study were to determine the most optimal timing to start machine perfusion during kidney preservation to improve early graft function and to evaluate the impact of temperature and oxygen supply during machine perfusion in a porcine ischemia-reperfusion autotransplant model. The left kidney of an approximately 40-kg female Belgian Landrace pig was exposed to 30 minutes of warm ischemia via vascular clamping and randomized to 1 of 6 study groups: (1) 22-hour static cold storage (SCS) (n = 6), (2) 22-hour hypothermic machine perfusion (HMP) (n = 6), (3) 22-hour oxygenated HMP (n = 7), (4) 20-hour HMP plus 2-hour normothermic perfusion (NP) (n = 6), (5) 20-hour SCS plus 2-hour oxygenated HMP (n = 7), and (6) 20-hour SCS plus 2-hour NP (n = 6)...
September 1, 2018: American Journal of Transplantation
Thomas Kerforne, Geraldine Allain, Sebastien Giraud, Delphine Bon, Virginie Ameteau, Pierre Couturier, William Hebrard, Jerome Danion, Jean-Michel Goujon, Raphael Thuillier, Thierry Hauet, Benoit Barrou, Christophe Jayle
Kidneys from donation after circulatory death (DCD) are highly sensitive to ischemia-reperfusion injury and thus require careful reconditioning, such as Normothermic Regional Perfusion (NRP). However, the optimal NRP protocol remains to be characterized. NRP was modeled in a DCD porcine model (30min of cardiac arrest) for 2h, 4h or 6h compared to a control group (noNRP); kidneys were machine-preserved and allotransplanted. NRP appeared to permit recovery from warm ischemia, possibly due to increased expression of HIF1α-dependent survival pathway...
August 9, 2018: American Journal of Transplantation
Rosana Gelpi, David Paredes, Camino Rodríguez-Villar, Rebeca Roque, Angel Ruiz, Ramon Adalia, Luis Peri-Cusí, Manel Sole, Federico Oppenheimer, Fritz Diekmann
Background: The criteria for kidney suitability in uncontrolled donors after circulatory death (uDCD) procured after regional normothermic perfusion are based on macroscopic appearance and renal haemodynamic values with final renal resistance (FRR). However, these criteria have not been analysed to predict the future graft function. This study presents a model to predict the outcome in uDCD kidneys and define the predictive FRR value. Methods: All uDCD kidney transplants performed in our hospital from 2004 to 2016 were included...
August 6, 2018: Nephrology, Dialysis, Transplantation
Charlotte von Horn, Thomas Minor
Normothermic machine perfusion can decrease reperfusion injury in renal transplantation. Clinical procurement logistics include retrieval and initial transport of the graft using static cold storage. Therefore, use and benefits of brief normothermic reconditioning by machine perfusion should be investigated in the initially cold preserved graft. Porcine kidneys (6 per group) were retrieved 20 min after cardiac standstill. After 20 h of static cold preservation some grafts were put on a machine perfusion circuit and normothermically perfused for 2 h at 35°C (NMP)...
2018: American Journal of Translational Research
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