Premium
Use of ex vivo normothermic machine perfusion after normothermic regional perfusion to salvage a poorly perfused DCD kidney
Author(s) -
Georgiades Fanourios,
Hosgood Sarah A.,
Butler Andrew J.,
Nicholson Michael L.
Publication year - 2019
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.15547
Subject(s) - medicine , machine perfusion , kidney , perfusion , transplantation , renal function , kidney transplantation , urology , surgery , liver transplantation
Normothermic regional perfusion ( NRP ) and normothermic machine perfusion ( NMP ) have both been used in the procurement and conditioning of abdominal organs from donation after circulatory death donors with reported improved outcomes for the recipients. Here, we describe an unusual case of a kidney that underwent NMP after NRP . After 2 hours of abdominal NRP , the intra‐abdominal organs were cold flushed in situ. The liver and right kidney were well flushed, but the left kidney was poorly flushed. Further attempts to clear the left kidney by flushing on the backtable were unsuccessful, and the kidney was thought to be unsuitable for transplant. The left kidney then underwent a 1‐hour period of NMP using a red cell–based perfusate. During NMP , the kidney met previously described quality assurance criteria for transplant with good global perfusion and adequate renal blood flow and urine production. The kidney was transplanted into a suitable recipient who had slow early graft function but did not require dialysis posttransplant. The recipient was discharged 6 days posttransplant, and the serum creatinine level was 160 μmol/L (1.8 mg/ dL ) at 2 months posttransplant.