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Machine perfusion kidney

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...
September 25, 2018: 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
Sandra K Kabagambe, Ivonne P Palma, Yulia Smolin, Tristan Boyer, Ivania Palma, Junichiro Sageshima, Christoph Troppmann, Chandrasekar Santhanakrishnan, John P McVicar, Kuang-Yu Jen, Miriam Nuño, Richard V Perez
BACKGROUND: Despite careful clinical examination, procurement biopsy and assessment on hypothermic machine perfusion (HMP), a significant number of potentially useable deceased donor kidneys will be discarded because they are deemed unsuitable for transplantation. Ex vivo normothermic perfusion (EVNP) may be useful as a means to further assess high-risk kidneys to determine suitability for transplantation. METHODS: From June 2014 to October 2015, 7 kidneys (mean donor age 54...
June 27, 2018: Transplantation
Fabian A Helfritz, Denisa Bojkova, Verena Wanders, Nina Kuklinski, Sandra Westhaus, Charlotte von Horn, Ursula Rauen, Anja Gallinat, Hideo A Baba, Andreas Skyschally, Sandra Swoboda, Volker Kinast, Eike Steinmann, Gerd Heusch, Thomas Minor, Philip Meuleman, Andreas Paul, Sandra Ciesek
Background: Although organ shortage is a rising problem, organs from HCV RNA positive donors are not routinely transplanted in HCV negative individuals. Since HCV only infects hepatocytes, other organs such as kidneys are merely contaminated with HCV via the blood. We here established a protocol to reduce HCV virions during the cold ischemic time. Material and Methods: Standard virological assays were used to investigate the effect of antivirals, including methylene blue (MB), in different preservation solutions...
June 23, 2018: Journal of Infectious Diseases
Victoria Gómez-Dos Santos, Mercedes Ruiz Hernández, Francisco Javier Burgos-Revilla
BACKGROUND: Hypothermic machine perfusion (HMP) of deceased donor kidneys is associated with a better outcome than static cold storage, predominantly in marginal donors. Nevertheless, there is little evidence supporting whether graft centre of origin and donor category impact HMP results. OBJECTIVE: To identify factors impacting HMP in transplantation from marginal donors. DESIGN, SETTING, AND PARTICIPANTS: Analysis of prospectively collected cohort data of expanded criteria donor (ECD) and donor after circulatory death (DCD) categories II and III was performed...
March 2018: European Urology Focus
Amanda Ali, Susan Addley, Stephen Ong
INTRODUCTION: We compared renal perfusion in normal pregnant women and women with pre-eclampsia using three-dimensional (3D) ultrasound. We measured the flow index (FI), vascular index (VI) and vascularisation flow index (VFI) which are believed to reflect vascularity and flow intensity. METHODS: Fourteen patients with normal pregnancy and 16 patients with pre-eclampsia were recruited. Imaging was conducted using a Voluson E8 machine and a 6-MHz trans-abdominal probe...
June 18, 2018: Irish Journal of Medical Science
V Opatrný, J Moláček, V Třeška, R Matějka, O Hes
INTRODUCTION: There is still a lack of organs for kidney transplantation. The aim of our experimental animal study was to improve the quality of the kidney grafts from donors after cardiac death (DCD) using immediate start of machine perfusion instead of perfusion based on hydrostatic pressure. METHODS: Ten rabbits were used as an experimental model. In group A, 5 kidneys after ischemic injury were perfused in situ using hydrostatic pressure. In group B, 5 kidneys were perfused in situ using machine pulsatile perfusion...
June 2018: Transplantation Proceedings
Jenna R DiRito, Sarah A Hosgood, Gregory T Tietjen, Michael L Nicholson
Normothermic machine perfusion (NMP) is a technique that utilizes extracorporeal membrane oxygenation to recondition and repair kidneys at near body temperature prior to transplantation. The application of this new technology has been fueled by a significant increase in the use of the kidneys that were donated after cardiac death, which are more susceptible to ischemic injury. Preliminary results indicate that NMP itself may be able to repair marginal organs prior to transplantation. In addition, NMP serves as a platform for delivery of therapeutics...
October 2018: American Journal of Transplantation
J Molacek, V Opatrný, V Treska, R Matejka, O Hes
INTRODUCTION: There is a worldwide discrepancy between the number of donors and the number of organs needed for transplantation, leading to certain expansion of criteria, resulting in acceptance of donor organs. This means that organs with worse parenchymal qualities may be harvested for transplantation. One possibility, how to ameliorate the quality of these organs, is to change the concept of their preservation during cold ischemia or even after sudden circulatory arrest, prior to the collection of the organ itself...
2018: Rozhledy V Chirurgii: Měsíčník Československé Chirurgické Společnosti
Annemarie Weissenbacher, Letizia Lo Faro, Olga Boubriak, Maria F Soares, Ian S Roberts, James P Hunter, Daniel Voyce, Nikolay Mikov, Andrew Cook, Rutger J Ploeg, Constantin C Coussios, Peter J Friend
Transportable normothermic kidney perfusion for 24 hours or longer could enable viability assessment of marginal grafts, increased organ use, and improved transplant logistics. Eleven clinically declined kidneys were perfused normothermically, with 6 being from donors after brain death (median cold ischemia time 33 ± 36.9 hours) and 5 being from donors after circulatory death (36.2 ± 38.3 hours). Three kidneys were perfused using Ringer's lactate to replace excreted urine volume, and 8 kidneys were perfused using urine recirculation to maintain perfusate volume without fluid replenishment...
May 14, 2018: American Journal of Transplantation
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