PD45-05 STEP-BY-STEP DEVELOPMENT OF A COLD ISCHEMIA DEVICE FOR OPEN AND ROBOT-ASSISTED RENAL TRANSPLANTATION

Abstract

You have accessJournal of UrologyRenal Transplantation & Vascular Surgery II (PD45)1 Sep 2021PD45-05 STEP-BY-STEP DEVELOPMENT OF A COLD ISCHEMIA DEVICE FOR OPEN AND ROBOT-ASSISTED RENAL TRANSPLANTATION Angelo Territo, Matteo Fontana, Andrea Gallioli, Alberto Piana, Pietro Diana, José Maria Gaya, Jorge Huguet, Pavel Gavrilov, Oscar Rodriguez Faba, Alex Mottrie, Carme Facundo, Lluís Guirado, Joan Palou, and Alberto Breda Angelo TerritoAngelo Territo More articles by this author , Matteo FontanaMatteo Fontana More articles by this author , Andrea GallioliAndrea Gallioli More articles by this author , Alberto PianaAlberto Piana More articles by this author , Pietro DianaPietro Diana More articles by this author , José Maria GayaJosé Maria Gaya More articles by this author , Jorge HuguetJorge Huguet More articles by this author , Pavel GavrilovPavel Gavrilov More articles by this author , Oscar Rodriguez FabaOscar Rodriguez Faba More articles by this author , Alex MottrieAlex Mottrie More articles by this author , Carme FacundoCarme Facundo More articles by this author , Lluís GuiradoLluís Guirado More articles by this author , Joan PalouJoan Palou More articles by this author , and Alberto BredaAlberto Breda More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002059.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Rewarming time can be associated with delayed graft function (DGF) due to ischemia/reperfusion damage. In both open kidney transplantation (OKT) and robotic assisted kidney transplantation (RAKT), ice slush is used to maintain graft temperature (GT) (target <20°C), preventing its impairment due to the rewarming time. This cooling technique is not able to keep a constant, equal temperature over the entire graft surface and can potentially provoke local or systemic hypothermia. The aim of a cold ischemia device (CID) is to maintain a constant low temperature of the entire graft while performing vascular anastomosis. METHODS: In IDEAL phase 1, CID was developed with bioengineers from GRENA Ltd. It consists of 2 layers of a thin film sealed to create a circuit, through which saline could flow in a closed system thanks to silicone tubes connected to a peristaltic pump and saline reservoir. CID was tested in the dry lab to determine whether it could keep a kidney at a constant low temperature, using 15 porcine kidneys: in 5 the device was used (group 1), in 5 a gauze jacket filled with ice slush was used (group 2), and in 5 no covering was used (group 3). The three groups of kidneys were introduced into a closed box with a predetermined temperature of 37.5°C, simulating the temperature of the abdominal cavity (38°C). The temperature was evaluated at scheduled timepoints from T0 (baseline) to T11 (50th minute). In phase 2a, CID was evaluated in porcine model (in-vivo) undergoing OKT and RAKT. In phase 2b, CID was tested in patients undergoing OKT and RAKT from living donors, monitoring GT with a thermal probe. Surgical procedures were performed according to standard technique. RESULTS: In IDEAL phase 1, CID proved able to maintain a low GT (<20°C) and was superior to both the gauze jacket filled with ice slush and no covering (p=0.002). In IDEAL phase 2a, CID allowed maintenance of a low and constant GT during both OKT (n=3) and RAKT (n=3), with a mean temperature at T11 of 10.8°C (SD 0.2) and 14.9°C (SD 0.1), respectively. In IDEAL phase 2b, demonstrated that both OKT (n=2) and RAKT (n=3) can be performed using CID in a clinical setting. In both approaches, GT never exceeded 20°C, with mean temperatures of 15.7°C and 18.3°C in OKT and RAKT, respectively. In all 5 cases, surgical times using CID were similar to the conventional approach. All (n=5) patients were discharged at post-op day 7; no cases of DGF were recorded. CONCLUSIONS: CID showed to keep a constant low GT in both OKT and RAKT. In terms of maneuverability and feasibility, it allows to perform vascular anastomosis within a satisfactory length of time. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e744-e744 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Angelo Territo More articles by this author Matteo Fontana More articles by this author Andrea Gallioli More articles by this author Alberto Piana More articles by this author Pietro Diana More articles by this author José Maria Gaya More articles by this author Jorge Huguet More articles by this author Pavel Gavrilov More articles by this author Oscar Rodriguez Faba More articles by this author Alex Mottrie More articles by this author Carme Facundo More articles by this author Lluís Guirado More articles by this author Joan Palou More articles by this author Alberto Breda More articles by this author Expand All Advertisement Loading ...