Advertisement

Machine Perfusion Preservation for Kidney Transplantation

  • Naoto Matsuno
Chapter

Abstract

The large gap between organ supply and demand emphasizes the importance of using all available donor sources. The shortage of donors for kidney transplantation is a universal problem. The waiting list has continued to grow, and the discrepancy between demand and supply is still increasing. The use of marginal donors is a promising way to increase the supply. In particular, the use of organs from non-heart-beating donors (NHBD) or donation after cardiac death (DCD) is acquiring increasing importance as a potential source of vital organs for clinical transplantation. However, with these expanded donor criteria (ECD), difficulties have been experienced because of preexisting organ damage from hypotension, which is associated with poor perfusion of kidney grafts. Unlike the recipients with heart beating donor kidneys, recipients of NHBD organs experience a higher incidence of primary nonfunction (PNF) and delayed graft function requiring postoperative hemodialysis (HD), prolonged hospitalization, and difficulties in the diagnosis of acute rejection. Long-term graft function and survival might be adversely affected by a delayed function of the kidneys after transplantation [1, 2]. The two approaches to preservation prior to transplantation are simple cold storage (SCS) and machine perfusion (MP). The simplicity, lower cost, and need for transport make cold storage the method of choice for the majority of renal transplant centers. However, continuous machine perfusion supplies or helps regenerate metabolic substances lost during warm ischemia and maintain near physiological conditions. It also maintains the intracellular pH and discharges waste, dilutes or neutralizes catabolic substances, and reduces sodium-dependent tissue edema (Fig. 15.1) [3, 4]. The histological integrity may be related to improved perfusion of the renal cortex microcirculation with the removal of red cells. These metabolic and physiological benefits lead to a reduction in the need for post-transplant dialysis by lowering the incidence of post-transplant acute tubular necrosis, resulting in a shorter hospital stay and better long-term survival. Another advantage of MP is the ability to perform viability testing. The perfusate chemistry, changes in the flow, and resistance during machine perfusion can be synchronously measured as a pretransplant viability test (Table 15.1). Within the marginal kidney donor pools, hypothermic machine perfusion (HMP) may be of major importance, because it can expand the utilization of ECD and DCD kidneys.

Keywords

Cold Storage Warm Ischemia Delay Graft Function Donation After Cardiac Death Machine Perfusion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Lin EC, Terasaki PL. Clinical transplants. In: Terasaki PL, editor. Eary graft function. Los Angeles: UCLA Tissue Typing Laboratory; 1992. p. 401.Google Scholar
  2. 2.
    Sellers MT, Callid MH, Hadson SL, et al. Improved outcomes cadaveric renal allograft with pulsatile preservation. Clin Transplant. 2009;14:543.CrossRefGoogle Scholar
  3. 3.
    Hoffman RM, Stratta RJ, D’Alessandro AM, et al. Combined cold storage-perfusion with a new synthetic perfusate. Transplantation. 1989;47:32–7.CrossRefGoogle Scholar
  4. 4.
    Yuan X, Thervath AJ, Ge X, et al. Machine perfusion or cold in organ transplantation: indication, mechanisms, and future perspectives. Transpl Int. 2010;23:561–70.PubMedCrossRefGoogle Scholar
  5. 5.
    Belzer FO, Park HY, Vetto RM. Factors influencing and blood flow during isolated perfusion. Surg Forum. 1964;15:222–4.PubMedGoogle Scholar
  6. 6.
    Belzer FO, Ashbly HY, Husang JS, et al. Etiology of rising perfusion pressure in isolated organ perfusion. Ann Surg. 1968;168(3):382–91.PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Belzer FO, Asbly BS, Dunphy JE, et al. 24 hour and 72 hour preservation of canine kidneys. Lancet. 1967;2(7515):536–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Belzer FO, Asbly BS, Gulyassy PI, et al. Successful seventeen-hour preservation and transplantation of human-cadaver kidney. N Eng J Med. 1968;278(1):608–10.Google Scholar
  9. 9.
    Belzer FO, Outhard JH. Principles of solid-organ preservation by cold storage. Transplantation. 1988;45(4):673–676.Google Scholar
  10. 10.
    Baumgariner D, Southard DE, Najarian JS. Studies on segmental pancreas autotransplants in dogs: technique and preservation. Transplant Proc. 1980;12(4 Suppl 2):163–71.Google Scholar
  11. 11.
    Claes G, Blohne I. Experimental and clinical results of continuous albumin perfusion of the kidneys. London: Churchill Livingstone; 1973.Google Scholar
  12. 12.
    Daemen J, Oomen A, Jansen M, et al. Glutathione transferase S- transferase as predictor of functional outcome in transplantation of machine preserved non-heart-beating donor kidneys. Transplantation. 1997;63:89–93.PubMedCrossRefGoogle Scholar
  13. 13.
    Grundmann R, Raab M, Meusel E, et al. Analysis of the optimal perfusion pressure and flow rate of the renal vascular resistance and oxygen consumption in the hypothermic perfused kidney. Surgery. 1975;77(3):451–61.PubMedGoogle Scholar
  14. 14.
    Hennry SD, Guarera JV. Prospective effects of hypothermic ex vivo perfusion on ischemia/ perfusion injury and transplant outcomes. Transplant Previews. 2012;26:163–75.CrossRefGoogle Scholar
  15. 15.
    Koyama H, Checka JM, Terasaki PI. A comparison of cadaver donor kidney storage methods: Pump perfusion and cold storage solutions. Clin Transplant. 1993;7:199–203.Google Scholar
  16. 16.
    Medez RG, Koussa N, et al. Preservation effect on oligo-anuria in the cyclosporine era; a prospective trial with 26 paired cadaveric renal allografts. Transplant Proc. 1987;19:2047–50.Google Scholar
  17. 17.
    Southard JH, Belzer FO. New concepts in organ preservation. Clin Transplant. 1997;7134–137.Google Scholar
  18. 18.
    Ajitani MR, Cutler JA, Det Valle CJ, et al. Single-donor cold storage versus machine perfusion in cadaver kidney transplantation. Transplantation. 1985;46:659–61.Google Scholar
  19. 19.
    Daemen JHC, de Vries B, Oomen APA, et al. Effect of machine perfusion preservation on delayed graft function in non-heart beating donor kidneys-Early results. Transpl Int. 1997;10:317–22.PubMedGoogle Scholar
  20. 20.
    Matsuno N, Sakurai E, Tamaki I, et al. Importance of machine perfusion flow in kidney transplantation. Transplant Proc. 1994;26(4):2421–2.PubMedGoogle Scholar
  21. 21.
    Kwiatkowski A, Wazola N, Kosieradzki M, et al. Machine perfusion preservation improves renal allograft survival. Am J Transplant. 2007;7:1942–7.PubMedCrossRefGoogle Scholar
  22. 22.
    Singh RP, Farney AC, Rojers J, et al. Kidney transplantation from donation after cardiac death donors: lack of impact of delayed graft function on post-transplant outcomes. Clin Transplant. 2011;25:255–64.PubMedCrossRefGoogle Scholar
  23. 23.
    Sigh RP, Farney AC, Rojers J, et al. Kidney transplantation from donation after cardiac death donors: lack of impact of delayed graft function on post-transplant outcomes. Clin Transplant. 2011;25:258–64.Google Scholar
  24. 24.
    Wight JP, Chilkott JB, Holmes MW, et al. Pulsatile machine perfusion vs cold storage of kidneys for transplantation: a rapid and systemic review. Clin Transplant. 2003;17:293–303.PubMedCrossRefGoogle Scholar
  25. 25.
    Mtasuoka L, Shah T, Aswad S, et al. Pulsatile perfusion reduces the incidence of delayed graft function in expanded criteria donor kidney transplantation. Am J Transplant. 2006;6:1473–8.CrossRefGoogle Scholar
  26. 26.
    Moers C, Smits JM, Maathuis MH, et al. Machine perfusion o cold storage in diseased donor kidney transplantation. N Eng J Med. 2009;360(1):78–80.Google Scholar
  27. 27.
    Treckmann J, Moers C, Smits JM, et al. Machine perfusion in clinical trials: machine vs solution effects. Transplant Int. 2012;25:e69–70.CrossRefGoogle Scholar
  28. 28.
    Charautrer N, Thuillier R, Barrou B, et al. Machine perfusion in clinical trials: the preservation solution bias. Transplant Int. 2011;24:e81–2.CrossRefGoogle Scholar
  29. 29.
    Moers C, Pirenne J, Paul A, et al. Machine perfusion or cold storage in deceased-donor kidney transplantation. N Engl Med. 2012;366:770–1.CrossRefGoogle Scholar
  30. 30.
    Watson C, Wells A, Roberts R, et al. Cold machine perfusion versus static storage of kidneys donated after cardiac death. A UK multicenter randomized controlled trial. Am J Transplant. 2010;10:1991–9.PubMedCrossRefGoogle Scholar
  31. 31.
    Buchanan PM, Lentine KL, Burroughs TE, et al. Association of lower cost of pulsatile machine perfusion in renal transplantation from expanded criteria donors. Am J Transplant. 2008;8:2391–401.PubMedCentralPubMedCrossRefGoogle Scholar
  32. 32.
    Garfield SS, Poret AW, Evans RW. The cost effectiveness of organ preservation methods in renal transplantation: US projections based on the machine preservation trial. Transplant Proc. 2009;41(9):3531–5.PubMedCrossRefGoogle Scholar
  33. 33.
    Groen H, Moers C, Smits JM, et al. Cost effectiveness of hypothermic machine preservation versus static cold storage in renal transplantation. Am J Transplant. 2012;12:1824–30.PubMedCrossRefGoogle Scholar
  34. 34.
    Balupuri S, Buckley P, Mohamed M, et al. Assessment of non-heart-beating donor (NHBD) kidneys for viability on machine perfusion. Clin Chem Lab Med. 2000;38(11):1103–6.PubMedGoogle Scholar
  35. 35.
    Codd JE, Garvin PJ, Morgan R, et al. Allograft viability determined by enzyme analysis. Transplantation. 1979;28:447–50.PubMedCrossRefGoogle Scholar
  36. 36.
    Kohn M, Ross H. Lactate dehydrogenase output of the excised kidney as index of acute ischemic renal damage. Transplantation. 1971;11:461–4.PubMedCrossRefGoogle Scholar
  37. 37.
    Liebau G, Kose HJ, Fischbach H, et al. Simple tests of viability of the hypothermic pulsatile perfused dog kidney. Surgery. 1971;70(39):459–66.PubMedGoogle Scholar
  38. 38.
    Matsuno N, Sakurai E, Uchiyama M, et al. Role of machine perfusion preservation in non-heart beating donors. Clin Transplant. 1998;1211–14.Google Scholar
  39. 39.
    Matsuno N, Konnnno O, Mejit A, et al. Application of machine perfusion preservation as a viability test for marginal kidney graft. Transplantation. 2006;82(11):1425–8.PubMedCrossRefGoogle Scholar
  40. 40.
    Tesi RI, Elkhammas EA, Davis EA, et al. Pulsatile kidney perfusion for evaluation of high-risk kidney donors safely expands the donor pool. Clin Transplant. 1994;8:114–8.Google Scholar
  41. 41.
    Balupuri S, Buckley P, Snowden C, et al. The trouble with kidneys derived from the non-heart beating source. A single center 10 year experience. Transplantation. 2000;69:842–6.PubMedCrossRefGoogle Scholar
  42. 42.
    Polyak MR, Arbrnoton B, Stubenbord WT, et al. The influence of pulsatile preservation on renal transplantation in the 1990. Transplantation. 2000;69(2):249–58.PubMedCrossRefGoogle Scholar
  43. 43.
    Sung RS, Christensen LL, Leichtman AB, et al. Determinants of discard of expanded criteria donor kidneys. Impact of biopsy and machine perfusion. Am J Transplant. 2008;8:783–92.PubMedCrossRefGoogle Scholar
  44. 44.
    Schold JD, Kaolan B, Howard RJ, et al. Are we frozen in time? Analysis of the utilization and efficacy of pulsatile perfusion in renal transplantation. Am J Transplant. 2005;5:1681–3.PubMedCrossRefGoogle Scholar
  45. 45.
    Nyberg SL, Matas A, Kremers W, et al. Improved scoring system to assess adult donors for cadaver renal transplantation. Am J Transplant. 2003;3:715–21.PubMedCrossRefGoogle Scholar
  46. 46.
    Nyberg SL, Baskin-Bet ES, Kremers W, et al. Improving the prediction of donor kidney quality; deceased donor score and resistive indices. Transplantation. 2005;80(7):925–9.PubMedCrossRefGoogle Scholar
  47. 47.
    Arcia-Valdecassas JR, Tabet J, Valero R, et al. Liver conditioning after cardiac arrest the use of normothermic recirculation in an experimental animal model. Transpl Int. 1998;11:424–9.CrossRefGoogle Scholar
  48. 48.
    Valero R, Cabrer C, Trias E, et al. Normothermic recirculation reduces primary graft dysfunction of kidneys obtained from non-heart-beating donors. Transpl Int. 2000;13:303–10.PubMedCrossRefGoogle Scholar
  49. 49.
    Samdovici M, Henning RH, van Goor H, et al. Systemic gene therapy with Interleukin-13 attenuates renal ischemia-reperfusion injury. Kidney Int. 2008;73:1364–73.CrossRefGoogle Scholar
  50. 50.
    Belzer FO, Glass NR, Sollinger HW, et al. A new perfusate for kidney preservation. Transplantation. 1982;33(3):322–3.PubMedGoogle Scholar
  51. 51.
    Hofmann RM, Southard JH, Luitz M, et al. Synthetic perfusate for kidney preservation. Its use in 72 h preservation of dog kidneys. Arch Surg. 1983;18(8):919–21.CrossRefGoogle Scholar
  52. 52.
    Maathuis MH, et al. Improved kidney graft function after preservation using a novel hypothermic machine perfusion device. Ann Surg. 2007;246:982.PubMedCrossRefGoogle Scholar
  53. 53.
    La Manna G, et al. In vivo autotransplant model of renal preservation cold storage versus machine perfusion in the preservation of ischemia/reperfusion injury. Artif Organs. 2009;33:565–70.PubMedCrossRefGoogle Scholar
  54. 54.
    Hosgood SA, et al. A comparison of hypothermic machine perfusion versus static cold storage in an experimental model of renal ischemia reperfusion injury. Transplantation. 2010;89:830–7.PubMedCrossRefGoogle Scholar
  55. 55.
    McAnulty JF, Ploeg RJ, Southard JH, et al. Successful five day perfusion preservation of canine kidney. Transplantation. 1989;47(1):37–41.PubMedCrossRefGoogle Scholar
  56. 56.
    Ploeg RJ, Vreugdenhil P, Goossens D, et al. Effect of pharmacologic agents on the function of the hypothermically preserved dog kidney during normothermic reperfusion. Surgery. 1988;103:676–83.PubMedGoogle Scholar
  57. 57.
    Hosgood SA, Bagul A, Yang B, et al. The relative effects warm and cold ischemic injury in an experimental model of nonheartbeating donor kidneys. Transplantation. 2008;85(1):88–92.PubMedCrossRefGoogle Scholar
  58. 58.
    Rojas-Pena A, Reoma JL, Krause E, et al. Extracorporeal support: Improves donor renal graft function after cardiac death. Am J Transplant. 2010;10:1365–74.PubMedCrossRefGoogle Scholar
  59. 59.
    Brasile L, Stubenitsky BM, Booster M, et al. Overcoming severe renal ischemia the role of ex vivo warm perfusion. Transplantation. 2002;73:890–7.CrossRefGoogle Scholar
  60. 60.
    Brasile L, Stubenitsky BM, Booster M, et al. Hypothermia-a limiting factor in using warm ischemically damaged kidneys. Am J Transplant. 2001;1:316–20.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Japan 2014

Authors and Affiliations

  1. 1.Division for Innovative Surgery and TransplantationNational Center for Child Health and DevelopmentTokyoJapan

Personalised recommendations