Organ storage in renal transplantation

Editorial Material Medicine, General & Internal

Normothermic Regional Perfusion-The Next Frontier in Organ Transplants?

Robert D. D. Truog et al.

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION (2023)

Article Immunology

Improved Organ Utilization and Better Transplant Outcomes With In Situ Normothermic Regional Perfusion in Controlled Donation After Circulatory Death

Gabriel C. Oniscu et al.

Summary: The use of normothermic regional perfusion (NRP) during controlled donation after circulatory death (cDCD) is associated with increased organ recovery and improved transplant outcomes.

TRANSPLANTATION (2023)

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Article Biochemistry & Molecular Biology

Normothermic machine perfusion versus static cold storage in donation after circulatory death kidney transplantation: a randomized controlled trial

Sarah A. Hosgood et al.

Summary: Kidney transplantation is the optimal treatment for end-stage renal disease, but the lack of suitable organ donors remains a severe limitation. Normothermic machine perfusion (NMP) is an emerging technique that maintains near-physiological conditions in donated kidneys, but its effectiveness in reducing delayed graft function (DGF) in donation after circulatory death (DCD) kidneys is still unclear. In a randomized controlled trial comparing NMP and conventional static cold storage (SCS), we found that a 1-hour NMP at the end of SCS did not reduce the rate of DGF in DCD kidneys. However, NMP was demonstrated to be feasible, safe, and suitable for clinical application without increasing any adverse events.

NATURE MEDICINE (2023)

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Review Medicine, General & Internal

Current Evidence and Future Perspectives to Implement Continuous and End-Ischemic Use of Normothermic and Oxygenated Hypothermic Machine Perfusion in Clinical Practice

Maxime Foguenne et al.

Summary: The use of high-risk renal grafts for transplantation requires the optimization of pretransplant assessment and preservation reconditioning strategies. Active oxygenation plays a central role in dynamic preservation strategies to recondition mitochondria and restore cellular energy. The differences between normothermic and hypothermic machine perfusion, as well as the logistic and economic implications, should be considered for implementation at a local level.

JOURNAL OF CLINICAL MEDICINE (2023)

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Article Transplantation

Normothermic Regional Perfusion Can Improve Both Utilization and Outcomes in DCD Liver, Kidney, and Pancreas Transplantation

Yuki Bekki et al.

Summary: This study examined the impact of thoracoabdominal NRP on the utilization and outcomes of liver, kidney, and pancreas transplantation in the United States. It was found that the use of thoracoabdominal NRP significantly increased the utilization rate of abdominal organs from DCD donors, with comparable outcomes after transplantation.

TRANSPLANTATION DIRECT (2023)

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Article Medicine, Research & Experimental

Sodium thiosulfate-supplemented UW solution protects renal grafts against prolonged cold ischemia-reperfusion injury in a murine model of syngeneic kidney transplantation

George J. Dugbartey et al.

Summary: In the experiment, it was found that preserving renal grafts in STS-supplemented UW solution can protect against prolonged cold IRI by suppressing apoptotic and inflammatory pathways, improving graft function, and prolonging recipient survival. This novel therapeutic strategy may help minimize the detrimental clinical outcome of prolonged cold IRI in kidney transplantation.

BIOMEDICINE & PHARMACOTHERAPY (2022)

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Review Gastroenterology & Hepatology

Machine perfusion in liver transplantation

Richard X. Sousa Da Silva et al.

Summary: Although liver transplantation is a success, many patients die while waiting for an organ. To address the increasing need for liver grafts, donor criteria have been expanded to include marginal grafts. However, these grafts carry a higher risk of complications. Machine perfusion, a procedure developed years ago, is of great interest in assessing graft viability and improving outcomes for recipients.

HEPATOLOGY (2022)

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Article Immunology

Normothermic Ex Vivo Kidney Perfusion for Human Kidney Transplantation: First North American Results

Laura Mazilescu et al.

Summary: This study demonstrates the safety and feasibility of normothermic ex vivo kidney perfusion (NEVKP) for deceased donor kidney transplantation. However, NEVKP did not show significant improvement in graft function and survival compared to traditional hypothermic machine perfusion. Further research is needed to explore the potential benefits of NEVKP in reducing cold ischemia, improving graft function, and assessing expanded criteria kidney grafts.

TRANSPLANTATION (2022)

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Review Pharmacology & Pharmacy

H2S donor molecules against cold ischemia-reperfusion injury in preclinical models of solid organ transplantation

George J. Dugbartey et al.

Summary: Cold ischemia-reperfusion injury is a major challenge in solid organ transplantation, and the use of hydrogen sulfide donor molecules has been shown to significantly mitigate this issue and improve transplant outcomes.

PHARMACOLOGICAL RESEARCH (2021)

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Article Surgery

Improved short-term outcomes of kidney transplants in controlled donation after the circulatory determination of death with the use of normothermic regional perfusion

Maria Padilla et al.

Summary: NRP in controlled DCDD kidney transplants shows better short-term outcomes compared to RR, with a lower risk of delayed graft function and 1-year graft loss in the NRP group.

AMERICAN JOURNAL OF TRANSPLANTATION (2021)

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Article Surgery

Effect of delayed graft function on longer-term outcomes after kidney transplantation from donation after circulatory death donors in the United Kingdom: A national cohort study

Benedict L. Phillips et al.

Summary: The presence of DGF does not impact long-term graft or patient survival, but a DGF duration of more than 14 days is associated with significantly worse longer-term outcomes.

AMERICAN JOURNAL OF TRANSPLANTATION (2021)

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Article Surgery

Oxygenated End-Hypothermic Machine Perfusion in Expanded Criteria Donor Kidney Transplant A Randomized Clinical Trial

Peri Husen et al.

Summary: In this randomized clinical trial, preimplantation short-term reconditioning of kidney grafts using oxygenated hypothermic machine perfusion did not lead to an improvement in 1-year graft survival compared to kidneys that underwent static cold storage alone, suggesting that this approach is not beneficial in kidneys retrieved from expanded criteria donors.

JAMA SURGERY (2021)

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Article Biochemistry & Molecular Biology

Subnormothermic Perfusion with H2S Donor AP39 Improves DCD Porcine Renal Graft Outcomes in an Ex Vivo Model of Kidney Preservation and Reperfusion

Smriti Juriasingani et al.

Summary: Cold preservation is the standard care for renal grafts, but research on alternatives like perfusion at higher temperatures and supplementing preservation solutions with hydrogen sulfide (H2S) has shown promising results. This study found that subnormothermic perfusion at 21 degrees C with H2S-supplemented blood improved renal graft outcomes, as indicated by increased urine output, reduced apoptotic injury, and changes in pro-survival gene expression patterns. Further research is needed for the clinical translation of this approach.

BIOMOLECULES (2021)

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Review Urology & Nephrology

Global Epidemiology of End-Stage Kidney Disease and Disparities in Kidney Replacement Therapy

John S. Thurlow et al.

Summary: The global epidemiology of ESKD varies between countries due to unique genetic, environmental, lifestyle, and sociodemographic characteristics. The response to ESKD, particularly regarding KRT, depends on the local disease burden, culture, and socioeconomics. Disparities in access to KRT exist globally, with a treatment gap in LMICs demanding a focus on prevention strategies and affordable KRT options. Achieving global equity in KRT access will require concerted efforts in public policy, health care delivery, workforce capacity, education, research, and support from various organizations.

AMERICAN JOURNAL OF NEPHROLOGY (2021)

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Article Surgery

Safety and feasibility of 2 h of normothermic machine perfusion of donor kidneys in the Eurotransplant Senior Program

E. Rijkse et al.

Summary: This pilot study demonstrates the safety and feasibility of normothermic machine perfusion (NMP) in kidneys transplanted within the ESP. Further well powered studies are needed to confirm these results and explore the potential benefits of NMP on graft outcomes.

BJS OPEN (2021)

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Article Surgery