Open AccessPreliminary experience of sequential use of normothermic and hypothermic oxygenated perfusion for donation after circulatory death kidney with warm ischemia time over the conventional criteria ‐ a retrospective and observational study
Author(s) -
Ravaioli Matteo,
De Pace Vanessa,
Comai Giorgia,
Capelli Irene,
Baraldi Olga,
D'Errico Antonietta,
Bertuzzo Valentina Rosa,
Del Gaudio Massimo,
Zanfi Chiara,
D'Arcangelo Giovanni Liviano,
Cuna Vania,
Siniscalchi Antonio,
Sangiorgi Gabriela,
La Manna Gaetano
Publication year - 2018
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/tri.13311
Subject(s) - medicine , ischemia , machine perfusion , organ donation , perfusion , kidney , pulsatile flow , circulatory system , renal function , kidney transplantation , anesthesia , surgery , urology , cardiology , transplantation , liver transplantation
Summary Donation after circulatory death (DCD) is a potential source of reducing organ demand. In Italy, DCD requires a 20‐min no‐touch period that prolongs warm ischemia and increases delayed graft function (DGF) risk and graft loss. We report here our preliminary experience of sequential use of normothermic regional perfusion (NRP), as standard procedure, and hypothermic oxygenated perfusion (HOPE), as an experimental technique of organ preservation, in 10 kidney transplants (KT) from five DCD Maastricht III with extensive functional warm ischemia time ( f WIT) up to 325 min. During NRP, renal function tests were evaluated to accept organs which were retrieved according to standard fashion with biopsy. While waiting for pathology and cross‐match results, organs were preserved with HOPE through pressure‐ and temperature‐controlled arterial pulsatile flow. All grafts with Karpinski score ≤4 were used for conventional single KT with mean cold ischemia time of 584 ± 167 min and mean f WIT of 151 ± 132 min. At the end of HOPE, lactate levels increased significantly in all cases with DGF ( P = 0.0095), which were 3/10 (30%). No primary nonfunctions were recorded, and all patients had sCr < 1.5 mg/dl at 6‐month post‐KT. NRP and HOPE for DCD may overcome f WIT limits safely, and lactate during HOPE predicts DGF.