Abstract
BackgroundMany kidneys are rejected for transplantation due to inadequate in situ perfusion during organ retrieval because of the risk of additional ischaemic injury and microvasculature thrombosis. This study describes the use of ex vivo normothermic perfusion (EVNP) for the resuscitation and assessment of human kidneys that were discarded after inadequate in situ perfusion.MethodsTwenty-two human kidneys were retrieved but then deemed unsuitable for transplantation, primarily due to inadequate in situ perfusion. After a period of static cold storage, kidneys were perfused for 60 min with an oxygenated red cell based solution at 36 °C.ResultsNineteen out of 22 kidneys (86 %) were from DCD donors. During EVNP, kidneys were assessed and scored based on their macroscopic appearance, measures of renal blood flow and urine production. Kidneys were scored from 1 indicating the least injury to 5, indicating the worst. Twelve kidneys had an EVNP score of 1–2, 7 scored 3–4 and 3 kidneys scored 5. The EVNP score 5 kidneys had a low level of tubular function compared to the score 1–4 kidneys. Their perfusion parameters did not improve during EVNP and they were considered non-transplantable. There was no association between the histological evaluation and EVNP parameters.ConclusionEVNP restores function ex vivo and enables an assessment of kidneys that have been declined for transplantation due to inadequate in situ perfusion.
Highlights
Many kidneys are rejected for transplantation due to inadequate in situ perfusion during organ retrieval because of the risk of additional ischaemic injury and microvasculature thrombosis
The successful utilisation of higher risk and donation after circulatory death (DCD) donor organs has undoubtedly contributed to the increase in the number of kidney transplants performed in the UK [1]
The aim of this study was to use ex vivo normothermic perfusion (EVNP) to resuscitate and evaluate kidneys declined primarily due to inadequate in situ perfusion and to assess their potential suitability for transplantation
Summary
Many kidneys are rejected for transplantation due to inadequate in situ perfusion during organ retrieval because of the risk of additional ischaemic injury and microvasculature thrombosis. The successful utilisation of higher risk and donation after circulatory death (DCD) donor organs has undoubtedly contributed to the increase in the number of kidney transplants performed in the UK [1]. Inadequate in situ perfusion is a common cause of kidney discard, in kidneys from DCD donors. The microcirculation is likely to be compromised and the cumulative damage caused by a period of hypothermic preservation can result in irreversible injury [2]. Many of these kidneys are regarded as unsuitable for transplantation [3]. An oxygenated red blood cell based solution is continuously re-circulated through the kidney
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