Impact of an intra-abdominal cooling device during open kidney transplantation in pigs.

Alban Longchamp,Nicola Colucci,Grgoire Longchamp,Manuel Pascual,Franois Lazeyras,Solange Moll,Jean-Marc Corpataux,Antoine Klauser,Alexandre Balaphas,Lorenzo A Orci,Antonio Nastasi,Leo Bhler,Raphael P H Meier

doi:10.4414/smw.2019.20143

Abstract

Transplantation of kidneys from deceased donors is still associated with a high rate of postoperative renal dysfunction. During implantation into the recipient, the kidney rewarms. This second warm ischaemia time, which is not monitored, is harmful especially if prolonged. We recently developed an intra-abdominal cooling device that efficiently prevents kidney rewarming during robotic transplantation, and prevents ischaemia-reperfusion injuries. We tested the benefits of this cooling device during open kidney transplantation in pigs. Kidneys were procured from large pigs by open bilateral nephrectomy. Following procurement, kidneys were flushed with 4°C Institut Georges Lopez-1 preservation solution, and placed on ice. Animals then underwent double sequential autologous open renal transplantation with (n = 7) and without (n = 6) intra-abdominal cooling. Mean anastomosis time was similar between groups (43.9 ± 13 minutes). At reperfusion, the renal cortex temperature was lower in the group with cooling (4.3 ± 1.1°C vs 26.5 ± 5.5°C, p <0.001). The cooled kidneys tended to be protected from injury, including some histopathological ischaemia-reperfusion lesions. With the device, kidneys had a better immediate postoperative urine output (p = 0.05). Our results indicate that the intra-abdominal cooling device significantly reduced second warm ischaemic time during transplantation, is technically safe and does not prolong anastomotic time.

Highlights

Kidney transplantation improves survival, is cost effective and offers the highest quality of life to patients with endstage renal disease [1–3]
We recently developed an intra-abdominal cooling device that efficiently prevents kidney rewarming during robotic transplantation, and prevents ischaemiareperfusion injuries
Mean anastomosis time was similar between groups (43.9 ± 13 minutes)

Summary

Introduction

Kidney transplantation improves survival, is cost effective and offers the highest quality of life to patients with endstage renal disease [1–3]. Kidney transplantation outcomes are variable, and depend on nonmodifiable factors such as donor and recipient age, pre-existing diseases or time on dialysis of the recipient, as well as modifiable factors such as graft warm ischaemic time [4]. Prolonged second warm ischaemic time (defined as the duration of the implantation) is a risk factor for delayed graft function [8]. Longer anastomosis times are associated with a higher rate of delayed graft function, acute and chronic rejection, and shorter graft survival [9, 10]. Anastomosis times above 45 minutes independently increased the risk of delayed graft function and impaired allograft function 3 years after transplantation [11]. Any delayed function has important implications, as it prolongs length of stay, increases the need for dialysis and adversely affects long-term survival [13–15]

Methods

Results

Conclusion