Effectivity of Hypothermic Machine Perfusion Preservation for Non-Heart-Beating Donor Kidney Transplantation in Japan

Abstract

Background In Japan, brain-dead donors have been increased by revised Act of Organ Transplantation, however, insufficiency of deceased donors is still serious problem. In kidney transplantation, it is important to use marginal donors such as non-heart-beating donors for solving this problem. Static cold storage (SCS) is the most widely used organ preservation method for deceased donor, and in Japan it is now the only technique for kidney preservation, however, hypothermic machine perfusion preservation (HMP) technique may improve better outcomes than SCS. HMP technology has had a major impact in circumventing ischemic injury in kidney transplantation in western countries. In this presentation, we report efficiency of HMP method for preservation of long ischemic kidney grafts in beagle and case reports of clinical usage to kidney transplantation of non-heat-beating donor in Japan. Methods Young beagles were used as autonomic HMP transplantation model. After general anesthesia of beagles, left renal artery and vein were made ligation, after 30 min warm ischemia time (WIT) in situ, the left kidney was harvested. Each harvested kidney was assigned to one of two preservation treatment groups; SCS group (storage in UW solution at 2-4°C for 24h, n=5); HMP group (storage on LifePort® (Organ Recovery Systems), at 4-6°C on 30 mmHg pressure for 24h with KPS-1 solution, n=5). After the storage, wedge biopsies were taken for histological evaluation. The preserved graft was transplanted to the same beagle in left iliac fossa and removed right kidney. After the operation, recipient survival and graft qualities (urine output, serum creatinine, sodium and potassium) were checked as the clinical outcomes. Results All recipients of HMP group survived, however, three recipients of SCS group were dead with uremia. Serum creatinine level of HMP group was under 4mg/dL in all post-operation period and reduced under 1.5mg/dL after 11days of post-operation. The other hands, those of SCS group went up over 5mg/dL and did not reduce under 3mg/dL. In histological findings, HE staining revealed that a little bit interstitial edema was exist with HMP groups, and remarkable interstitial edema and vaculolation were exist with SCS group. Clinical Cases We performed three cases of renal transplant with HMP graft from non-heart-beating donor. The all three recipients were discharged hospital without any complications with achieved withdrawal of hemodialysis. HMP reduced the duration of delayed graft function and graft function with HMP was same as that with SCS. Conclusion In this experiment, we indicate that HMP would be better for long term WIT kidney model compared with SCS method in beagles. We experienced three clinical cases of non-heart-beating donor kidney transplantation with LifePort® preserved graft in Japan. It suggests that with marginal donor that is non-heart-beating and is with long agony, HMP should be paid more tribute to than SCS technique.