Waters Medical Systems

Machine Measured Renal Resistance (MMRR) is the most sensitive tool for prediction of early renal allograft survival.

Studies have recognized the relationship among renal allograft resistance, graft function and survival. The relationship of MMRR and chronic allograft pathology remains unstudied.

By Y.Y. Yushkov et al.

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Method

Method: We performed a retrospective analysis of 1181 deceased donor kidneys transplanted in a large donor service area (DSA) from 2007-2009. All kidneys were evaluated using MMRR and Optimized Needle Biopsy Technique protocol. All biopsies were frozen section evaluations performed by a single transplant pathology laboratory for the DSA. The pathology report identified the following renal allograft parameters: 1. Total number of glomeruli/number of obsolete glomeruli (GS); 2. Tubular interstitial scarring (TIS); 3. Intimal fibrous narrowing of arteries (IFN). MMRR was measured after 3 hours of machine perfusion based on previous studies indicating this is the earliest time to predict a difference in graft survival by MMRR cohorts. Based upon MMRR, allografts were separated into three groups: < 0.2, 0.2-0.3, >0.3. Renal function at 1 year was measured using e-GFR (MDRD). ANOVA was used to correlate pre-transplant MMRR with GS, TIS, IFN and 1-year recipient e-GFR.

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Machine perfusion following static cold storage preservation in kidney transplantation

Donor-matched pairanalysis of the prognostic impact of longer pump time

By Gaetano Ciancio et al.

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Summary

The impact of machine perfusion (MP) time on kidney transplant outcome is mixed in previous studies using multivariable analyses. In an analysis of 66 pairs of donor-matched adult, first transplant recipients (N = 132) with identical donor characteristics except for pump time, tests of association of shorter versus longer pump time (first versus second kidney removed) by delayed graft function(DGF), slow graft function(SGF), and biopsy proven acute rejection (BPAR) were performed using McNemar’s test. Freedom-from-BPAR, graft and patient survival, and renal function were also compared. Mean ± SD pump times for paired recipients with first and second kidneys were 22.7 ± 7.3 h and 31.2 ± 7.9 h, respectively (mean difference: 8.5 ± 4.5 h, P < .000001). There was no significant impact of pump time on DGF or SGF, with discordant pairs favoring less SGF with longer pump time (N.S.). The incidence of BPAR during the first 12 months post-transplant yielded a borderline difference favoring longer pump time (P = .09), and freedom-from-BPAR during the first 12 months was significantly more favorable for longer pump times (95% vs. 84%, P = 0.04). No differences were observed in graft and patient survival, and renal function. While offering significantly favorable protection from BPAR, this analysis of donor-matched recipient pairs corroborates longer MP (pump) times having no unfavorable effect on other clinical outcomes.

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Favorable Outcomes With Machine Perfusion and Longer Pump Times in Kidney Transplantation

A Single-Center, Observational Study.

By Gaetano Ciancio et al

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Hypothermic machine perfusion (MP) preservation is used for all deceased donor kidney transplants at our center. Kidneys are placed in cold storage at retrieval, then transferred to MP on arrival. Because a lack of consensus regarding optimal use of MP still exists, we evaluated the overall impact of using MP at our center and the prognostic value of MP (Pump) time.
Methods. We retrospectively analyzed 339 adult, primary deceased donor kidney transplant recipients who were pooled across three prospective, randomized immunosuppression trials (since 2000) at our center. In addition to providing overall results for delayed graft function (DGF) (requirement for dialysis in the first week), slow graft function (SGF), first biopsy-proven acute rejection (BPAR), and graft failure, stepwise logistic and Cox regression analyses were used to determine the prognostic value of pump time, particularly after controlling for other significant prognosticators.

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Current State of Hypothermic Machine Perfusion Preservation of Organs: The Clinical Perspective


Focusing on the application of hypothermic perfusion technology as a topic of current interest with the potential to improve the quantity and quality of donor organs and the outcome of transplantation. 


By Michael J. Taylor

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Abstract

This review focuses on the application of hypothermic perfusion technology as a topic of current interest with the potential to have a salutary impact on the mounting clinical challenges to improve the quantity and quality of donor organs and the outcome of transplantation. The ex vivo perfusion of donor organs on a machine prior to transplant, as opposed to static cold storage on ice, is not a new idea but is being re-visited because of the prospects of making available more and better organs for transplantation. The rationale for pursuing perfusion technology will be discussed in relation to emerging data on clinical outcomes and economic benefits for kidney transplantation. Reference will also be made to on-going research using other organs with special emphasis on the pancreas for both segmental pancreas and isolated islet transplantation. Anticipated and emerging benefits of hypothermic machine perfusion of organs are: (i) maintaining the patency of the vascular bed, (ii) providing nutrients and low demand oxygen to support reduced energy demands, (iii) removal of metabolic by-products and toxins, (iv) provision of access for administration of cytoprotective agents and/or immunomodulatory drugs, (v) increase of available assays for organ viability assessment and tissue matching, (vi) facilitation of a change from emergency to elective scheduled surgery with reduced costs and improved outcomes, (vii) improved clinical outcomes as demonstrated by reduced PNF and DGF parameters, (viii) improved stabilization or rescue of ECD kidneys or organs from NHBD that increase the size of the donor pool, (ix) significant economic benefit for the transplant centers and reduced health care costs, and (x) provision of a technology for ex vivo use of non-transplanted human organs for pharmaceutical development research.

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Preservation Methods for Kidney and Liver


For every patient that receives a transplanted organ, there are four more on the waiting list. In addition, a patient dies from the lack of a transplant almost every 11/2 hour.

By Charles Y. Lee et al.

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Summary

With the successful testing of the immunosuppressive effects of cyclosporine in transplant patients in 1978, the field of organ transplants began an exponential growth. With that, the field of organ preservation became increasingly important as the need to increase preservation time and improve graft function became paramount. However, for every patient that receives a transplanted organ, there are four more on the waiting list. In addition, a patient dies from the lack of a transplant almost every 1½ hour. To alleviate this donor crisis, there is a need to expand the donor pool to marginal donor organs. The main reason these organs are underutilized is because the current method of static preservation, simple cold storage, is ineffective. This article will provide a general review of the methods of preservation including simple cold storage, hypothermic machine perfusion, normothermic machine perfusion, and oxygen persufflation. In addition, the article will provide a review of how these dynamic preservation methods have improved the recovery and preservation of marginal donor organs including Donation after Cardiac Death and Fatty livers.

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Influence of Pulsatile Perfusion Preservation on Outcomes in Kidney Transplantation from Expanded Criteria Donors


Retrospective analysis of intermediate-term outcomes in ECD kidney transplantations according to method of preservation at a single center using a standardized approach.

By Robert J Stratta et al.

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Background

Expanded criteria donors (ECDs) increase the donor organ pool, but the value of transplanting
these kidneys has been questioned because of concerns about diminished survival, poorer renal
function, and higher rates of delayed graft function.


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The influence of pulsatile and non-pulsatile extracorporeal circulation on fluid retention following coronary artery bypass grafting

Thirty male patients undergoing coronary artery bypass grafting were divided into two groups, group I receiving pulsatile perfusion, group II non-pulsatile perfusion. 

By T. Thompson et al.

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Abstract (summarized)

 Thirty male patients undergoing coronary artery bypass grafting were divided into two groups, group I receiving pulsatile perfusion, group II non-pulsatile perfusion. 

A double roller pump system for extracorporeal circulation was employed. Intra- and postoperative fluid balances and bodyweight gains were controlled under clinical conditions. There were no significant differences between the groups with regard to clinical data, operative procedure, perfusion parameters, drug treatment or intensive care treatment. The intra-operative mean fluid balance of group I was 794.0ml (66%) lower than that of group II, while the balance 24 hours postoperatively was 136.7ml (37%) lower in group I.

The total mean fluid balance for the pulsatile group was 931.0ml (59%) lower than the non-pulsatile group, in accordance with the bodyweights, which showed a 954.0g (63%) lower outcome in the pulsatile group. Less supplementary volume and higher urine production were the main factors. 

It appears that volume saved during pulsatile ECC need not be replaced postoperatively. 

These findings indicate that pulsatile perfusion leads to diminished fluid overloading, which could be an important advantage, especially for high-risk patients.

 

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Improved Immediate Renal Allograft Function After Initial Simple Cold Storage


Immediate renal allograft function has been identified as being an important variable in ultimate graft survival.

By M. L. Henry

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Summary

Immediate renal allograft function has been identified as being an important variable in ultimate graft survival.1 Simple cold storage, particularly if preserved for longer than 24 hours, can chave a high incidence of early dysfunction (ED) when cylosporine is used as immediate post transplant immunotherapy.2 Because of the importance of immediate function (IF) and our prejudice toward pulsatile perfusion (PP), we began to place all imported kidnesy previously preserved by simple cold storage onto the PP machine for preservation before transplantation at our center. The following is a description of the outcomes of this trial.


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