Abstract
Purpose. Kidneys from DCD donors represent a significant pool, but preservation problems exist. The study objective was to test the importance of machine type for hypothermic preservation of DCD kidneys. Methods. Adult Beagle dog kidneys underwent 45 minutes of warm in situ ischemia followed by hypothermic perfusion for 24 hours (Belzer-MPS Solution) on either an ORS LifePort or a Waters RM3 using standard perfusion protocols. Kidneys were then autotransplanted, and renal function was assessed over 7 days following contralateral nephrectomy. Results. Renal vascular resistance was not different between the two pumps. After 24 hours, the oxygen partial pressure and oxygen delivery in the LifePort perfusate were significantly lower than those in the RM3 but not low enough to change lactate production. TheLifePort ran significantly colder than RM3 (2° versus 5°C). The arterial pressure waveform of the RM3 was qualitatively different from the waveform of the LifePort. Preservation injury after transplantation was not different between the devices. When the LifePort was changed to nonpulsatile flow, kidneys displayed significantly greater preservation injury compared to RM3. Conclusions. Both LifePort and RM3 can be used for hypothermic machine perfusion preservation of DCD kidneys with equal outcomes as long as the duty cycle remains pulsatile.
Highlights
Renal transplantation continues to be the treatment of choice for patients with end stage renal disease
The temperature of operation of the Waters machine was significantly higher than the ORS LifePort (5.5∘C versus 2.2∘C, resp.)
While the metabolic demand was slightly higher in the warmer Waters machine, the delivery of oxygen was significantly higher than LifePort too
Summary
Renal transplantation continues to be the treatment of choice for patients with end stage renal disease. One source of kidney donors that have gained considerable attention over the last decade is Donation after Cardiac Death (DCD). It has been estimated that of the 335,000 cardiac deaths that occurred in 2006, at least 22,000 (7%) may meet the criteria for uncontrolled DCD donation [3]. This has the conservative potential of unleashing 44,000 kidneys per year into the donor pool, which could seriously alleviate the donor shortage since the total number of all deceased donor kidney transplants in the USA in all of 2011 was only 11,043. While the effects of 30–90 minutes of warm renal ischemia per se produce
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