Pulsatile perfusion: A preservation strategy to optimize the use and function of transplanted kidneys

Current Opinion in Organ Transplantation

Volumn 12, Issue 4, 2007, Pages 345-350

  Bumgardner, Ginny L ^a   Henry, Mitchell L ^a  

^a THE OHIO STATE UNIVERSITY WEXNER MEDICAL CENTER   (United States)

Author keywords

Delayed graft function; Kidney transplant

Indexed keywords

BASILIXIMAB; CYCLOSPORIN A; MYCOPHENOLIC ACID 2 MORPHOLINOETHYL ESTER; PREDNISONE;

ACCURACY; CELL MEMBRANE PERMEABILITY; COST EFFECTIVENESS ANALYSIS; CRYOPRESERVATION; GRAFT FAILURE; GRAFT SURVIVAL; HEALTH CARE UTILIZATION; HEALTH PROGRAM; HEART DEATH; HEMODIALYSIS; HOSPITALIZATION; HUMAN; IMMUNOSUPPRESSIVE TREATMENT; INCIDENCE; KIDNEY ALLOGRAFT; KIDNEY DONOR; KIDNEY FUNCTION; KIDNEY GRAFT REJECTION; KIDNEY PERFUSION; KIDNEY PRESERVATION; KIDNEY TRANSPLANTATION; MEDICAL TECHNOLOGY; MORBIDITY; QUALITATIVE ANALYSIS; REVIEW; RISK FACTOR; STATISTICAL SIGNIFICANCE; TREATMENT OUTCOME;

EID: 34447542429     PISSN: 10872418     EISSN: 15317013     Source Type: Journal    
DOI: 10.1097/MOT.0b013e32823f9ebf     Document Type: Review

References (25)

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8. de Vries B, Snoeijs MG, von Bonsdorff L, et al. Redox-active iron released during machine perfusion predicts viability of ischemically injured deceased donor kidneys. Am J Transplant 2006; 6:2686-2693. This is an interesting article that provides translational correlation of observations derived from basic research. The authors reported previously on the correlation of redox-active iron with experimental renal ischemia-reperfusion injury in mice; this injury was attenuated by administration of the iron chelator apotransferrin. The findings from this recent study show that, as the authors predicted, circulating redox-active iron released into the pulsatile perfusion perfusate reflected the degree of warm ischemia time in non-heart-beating donors and also correlated with primary nonfunction.
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17. Stratta RJ, Rohr MS, Sundberg AK, et al. Intermediate-term outcomes with expanded criteria deceased donors in kidney transplantation: a spectrum or specter of quality? Ann Surg 2006; 243:594-601; discussion 601-603. This article demonstrates in a small cohort of pulsatile perfusion kidneys transplanted after being turned down (11 of 14) by a number of other centers based on pulsatile perfusion parameters and donor quality that, after pulsatile perfusion at their local center, flow rates increased and renal resistance decreased substantially. This effect followed chemical interventions including mannitol to adjust perfusate osmolality, and sodium bicarbonate to adjust pH. Despite the long cold ischemia time (>40 h) these kidneys had good kidney function, with a serum creatinine of 1.6 ± 0.4 mg/dl at a median follow-up of 12 months. Six of 11 patients at follow-up had mild proteinuria, none greater than 400 mg/24 h.
18. Matsuoka L, Shah T, Aswad S, et al. Pulsatile perfusion reduces the incidence of delayed graft function in expanded criteria donor kidney transplantation. Am J Transpl 2006; 6:1473-1478. Excellent study with large sample size from the UNOS database (n = 4618) focusing on the effect of pulsatile perfusion (n = 912) compared with cold storage (n = 3706) on DGF in ECD kidney transplant alone. DGF was defined as the need for dialysis during the first week following transplant. The study reports a significant decrease in DGF for pulsatile perfusion (26%) compared with cold storage (37%) (P < 0.001). The authors also report a trend towards decreased graft survival rate in ECD cold storage kidneys compared with ECD pulstile perfusion kidneys.
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