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Abstract
Introduction: Recent studies have shown that maintaining kidney viability with expanded criteria during preservation is a challenge. The hypothermic infusion machine aims to mitigate the effect of cold storage on the quality of the organ when the time of cold ischemia is prolonged or the donor is suboptimal. Objective: To evaluate the complications presented by renal transplanted patients with cold static preservation or hypothermic pulsatile perfusion. Material and Method: Retrospective observational study during 2010-2012, including all kidney transplant patients in a third level hospital. The study variables: length of stay, hours of ischemia, need for dialysis and number of post-transplant sessions and the storage device, age and pathologies associated with the donor. Results: 175 transplants were performed, 70 of which were donors =65 years old. 30 kidneys were perfused in a machine and static preservation was used in 40. Our findings regarding the use of the infusion machine lead to a decrease in the average length of stay and a reduced need for post-transplant haemodialysis. Conclusions: Due to the high percentage of organs difficult to preserve and from elderly donors, it is essential to seek continuous intravascular perfusion techniques for a more effective preservation of the organ.
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References
- García-García G, Harden P, Chapman J. The global role of kidney transplantation. Nefrologia 2012;32(1):1-6. DOI: https://doi.org/10.5301/jn.5000113
- Moers C, Kornmann NS, Leuvenink HG, Ploeg RJ. The influence of deceased donor age and old-for-old allocation on kidney transplant outcome. Transplantation 2009;88(4):542-52. DOI: https://doi.org/10.1097/TP.0b013e3181b0fa8b
- Saidi RF, Elias N, Kawai T, Hertl M, Farrell ML, Goes N, et al. Outcome of kidney transplantation using expanded criteria donors and donation after cardiac death. Am J Transplant 2007;7:2769-74. DOI: https://doi.org/10.1111/j.1600-6143.2007.01993.x
- Audard V, Matignon M, Dahan K, Lang P, Grimbert P. Renal transplantation from extended criteria cadaveric donors: problems and perspectives overview. Transpl Int 2008;21:11-7.
- Wynn J, Alexander C. Increasing organ donation and transplantation: the U.S. experience over the past decade. Transpl Int 2011;24:324-32. DOI: https://doi.org/10.1111/j.1432-2277.2010.01201.x
- Valeri M, Torlone N, Meçule A. Five years experience in a senior kidney donor programme. Cells Tissues Organs 2006;2:99-102.
- Ojo AO, Hanson JA, Meier-Kriesche H, Okechukwu CN, Wolfe RA, Leichtman AB, et al. Survival in recipients of marginal cadaveric donor kidneys compared with other recipients and wait-listed transplant candidates. J Am Soc Nephrol 2001;12:589-97. DOI: https://doi.org/10.1681/ASN.V123589
- Rao PS, Merion RM, Ashby VB, Port FK, Wolfe RA, Kayler LK. Renal transplantation in elderly patients older than 70 years of age: results from the Scientific Registry of Transplant Recipients. Transplantation 2007;83(8):1069-74. DOI: https://doi.org/10.1097/01.tp.0000259621.56861.31
- Wolfe RA, Ashby VB, Milford EL, Ojo AO, Ettenger RE, Agodoa LY, et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med 1999;341(23):1725-30. DOI: https://doi.org/10.1056/NEJM199912023412303
- Escalante JL, Río F. Preservación de órganos. Med Intensiva 2009;33(6):282-92. DOI: https://doi.org/10.1016/S0210-5691(09)72196-5
- Organización Nacional de Trasplantes. Memoria actividad donación y trasplante renal. España 2018. [Internet] [Consultado 2 mar 2019]. Disponible en: http://www.ont.es/infesp/Memorias/Actividad%20de%20Donaci%C3%B3n%20y%20Trasplante%20Renal.pdf.
- Treckmann J, Moers C, Smits JM, Gallinat A, Maathuis MH, Van Kasterop-Kutz M, et al. Machine perfusion versus cold storage for preservation of kidneys from expanded criteria donors after brain death. Transpl Int 2011;24:548. DOI: https://doi.org/10.1111/j.1432-2277.2011.01232.x
- Metzger RA, Delmonico FL, Feng S, Port FK, Wynn JJ, Merion RM. Expanded criteria donors for kidney transplantation. Am J Transplant 2003;3(4):114-25. DOI: https://doi.org/10.1034/j.1600-6143.3.s4.11.x
- Groen H, Moers C, Smits JM, Treckmann J, Monbaliu D, Rahmel A, et al. Cost-effectiveness of hypothermic machine preservation versus static cold storage in renal transplantation. Am J Transplant 2012;12:1824-30.
- Choy YW, Bunnapradist S, Choe ES, Stadtler M, Simmons V, Locke J, et al. Can machine perfusion decrease the likelihood of discard among biopsied kidneys? Transplant Proc 2008;40:1029-31. DOI: https://doi.org/10.1016/j.transproceed.2008.03.062
- Moers C, Smits JM, Maathuis MH, Treckmann J, Van Gelder F, Napieralski BP, et al. Machine perfusion or cold storage in deceased-donor kidney transplantation. N Engl J Med 2009;360:7-19. DOI: https://doi.org/10.1056/NEJMoa0802289
- Wight JP, Chilcott JB, Holmes MW, Brewer N. Pulsatile machine perfusion vs cold storage of kidneys for transplantation: a rapid systematic review. Clin Transplant 2003;17:293-307.
- Wszola M, Kwiatkowski A, Latek M, Ostrowski K, Domagala P, Ciszek M, et al. Long term medical and economical benefit of machine perfusion storage in comparison to cold storage. Ann Transplant 2009;14(2):24-9.
- Matsuoka l, Almeda J, Mateo R. Pulsatile perfusion of kidney allografts. Curr Opin Organ Transplant 2009;14(4):365-69. DOI: https://doi.org/10.1097/MOT.0b013e32832dbd1c
- Domagala P, Kwiatkowski A, Perkowskaa-Ptasinska A, Wszola M, Panufnik L, Paczek L, et al. Assessment of kidneys procured from expanded criteria donors before transplantation. Transplant Proc 2009;41:2966-69. DOI: https://doi.org/10.1016/j.transproceed.2009.08.004
- Kwiatkowski A, Wszola M, Perkowska-PtasinsKa A, Ostrowski K, Domagala P, Fesolowicz S, et al. Influence of preservation method on histopathological lesions of kidney allografts. Ann Transplant 2009;14:10-3.
- Wight JP, Chilcott JB, Holmes MW, Brewer N. Pulsatile machine perfusion vs cold storage of kidneys for transplantation: a rapid and systematic review. Clin Transplant 2003;17:293-307. DOI: https://doi.org/10.1034/j.1399-0012.2003.00077.x
- Groen H, Moers C, Smits JM, Treckmann J, Monbaliu D, Rahmel A, et al. Long Term Cost-Effectiveness of Hypothermic Machine Perfusion Versus Static Cold Storage in Kidney Transplantation. Am J Transplant 2012;12(7):1824-30. DOI: https://doi.org/10.1111/j.1600-6143.2012.04030.x
- Ureña A, Fernández O, Arango A, Rebollo P. Calidad de vida en trasplante renal. En: Libro de comunicaciones del XXI Congreso de la Sociedad Española de Enfermería Nefrológica. Barcelona: HOSPAL; 1996.
- Garfield S, Evans R. Machine perfusion cost-effectiveness versus cold storage has been demonstrated; limiting use to marginal donor kidneys unjustified. Transpl Int 2010;23:67-8. DOI: https://doi.org/10.1111/j.1432-2277.2010.01164.x
- Lenihan C, O’Kelly P, Mohan P, Little D, Walshe JJ, Kieran NE, et al. MDRD-estimated GFR at one year post-renal transplant is a predictor of long-term graft function. Ren Fail 2008;30:345-52. DOI: https://doi.org/10.1080/08860220801947686
- Stratta RJ, Rohr MS, Sundberg AK, Armstrong G, Hairston G, Hartmann E, et al. Increased kidney transplantation utilizing expanded criteria deceased organ donors with results comparable to standard criteria donor transplant. Ann Surg 2004;239:688-95. DOI: https://doi.org/10.1097/01.sla.0000124296.46712.67
References
García-García G, Harden P, Chapman J. The global role of kidney transplantation. Nefrologia 2012;32(1):1-6. DOI: https://doi.org/10.5301/jn.5000113
Moers C, Kornmann NS, Leuvenink HG, Ploeg RJ. The influence of deceased donor age and old-for-old allocation on kidney transplant outcome. Transplantation 2009;88(4):542-52. DOI: https://doi.org/10.1097/TP.0b013e3181b0fa8b
Saidi RF, Elias N, Kawai T, Hertl M, Farrell ML, Goes N, et al. Outcome of kidney transplantation using expanded criteria donors and donation after cardiac death. Am J Transplant 2007;7:2769-74. DOI: https://doi.org/10.1111/j.1600-6143.2007.01993.x
Audard V, Matignon M, Dahan K, Lang P, Grimbert P. Renal transplantation from extended criteria cadaveric donors: problems and perspectives overview. Transpl Int 2008;21:11-7.
Wynn J, Alexander C. Increasing organ donation and transplantation: the U.S. experience over the past decade. Transpl Int 2011;24:324-32. DOI: https://doi.org/10.1111/j.1432-2277.2010.01201.x
Valeri M, Torlone N, Meçule A. Five years experience in a senior kidney donor programme. Cells Tissues Organs 2006;2:99-102.
Ojo AO, Hanson JA, Meier-Kriesche H, Okechukwu CN, Wolfe RA, Leichtman AB, et al. Survival in recipients of marginal cadaveric donor kidneys compared with other recipients and wait-listed transplant candidates. J Am Soc Nephrol 2001;12:589-97. DOI: https://doi.org/10.1681/ASN.V123589
Rao PS, Merion RM, Ashby VB, Port FK, Wolfe RA, Kayler LK. Renal transplantation in elderly patients older than 70 years of age: results from the Scientific Registry of Transplant Recipients. Transplantation 2007;83(8):1069-74. DOI: https://doi.org/10.1097/01.tp.0000259621.56861.31
Wolfe RA, Ashby VB, Milford EL, Ojo AO, Ettenger RE, Agodoa LY, et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med 1999;341(23):1725-30. DOI: https://doi.org/10.1056/NEJM199912023412303
Escalante JL, Río F. Preservación de órganos. Med Intensiva 2009;33(6):282-92. DOI: https://doi.org/10.1016/S0210-5691(09)72196-5
Organización Nacional de Trasplantes. Memoria actividad donación y trasplante renal. España 2018. [Internet] [Consultado 2 mar 2019]. Disponible en: http://www.ont.es/infesp/Memorias/Actividad%20de%20Donaci%C3%B3n%20y%20Trasplante%20Renal.pdf.
Treckmann J, Moers C, Smits JM, Gallinat A, Maathuis MH, Van Kasterop-Kutz M, et al. Machine perfusion versus cold storage for preservation of kidneys from expanded criteria donors after brain death. Transpl Int 2011;24:548. DOI: https://doi.org/10.1111/j.1432-2277.2011.01232.x
Metzger RA, Delmonico FL, Feng S, Port FK, Wynn JJ, Merion RM. Expanded criteria donors for kidney transplantation. Am J Transplant 2003;3(4):114-25. DOI: https://doi.org/10.1034/j.1600-6143.3.s4.11.x
Groen H, Moers C, Smits JM, Treckmann J, Monbaliu D, Rahmel A, et al. Cost-effectiveness of hypothermic machine preservation versus static cold storage in renal transplantation. Am J Transplant 2012;12:1824-30.
Choy YW, Bunnapradist S, Choe ES, Stadtler M, Simmons V, Locke J, et al. Can machine perfusion decrease the likelihood of discard among biopsied kidneys? Transplant Proc 2008;40:1029-31. DOI: https://doi.org/10.1016/j.transproceed.2008.03.062
Moers C, Smits JM, Maathuis MH, Treckmann J, Van Gelder F, Napieralski BP, et al. Machine perfusion or cold storage in deceased-donor kidney transplantation. N Engl J Med 2009;360:7-19. DOI: https://doi.org/10.1056/NEJMoa0802289
Wight JP, Chilcott JB, Holmes MW, Brewer N. Pulsatile machine perfusion vs cold storage of kidneys for transplantation: a rapid systematic review. Clin Transplant 2003;17:293-307.
Wszola M, Kwiatkowski A, Latek M, Ostrowski K, Domagala P, Ciszek M, et al. Long term medical and economical benefit of machine perfusion storage in comparison to cold storage. Ann Transplant 2009;14(2):24-9.
Matsuoka l, Almeda J, Mateo R. Pulsatile perfusion of kidney allografts. Curr Opin Organ Transplant 2009;14(4):365-69. DOI: https://doi.org/10.1097/MOT.0b013e32832dbd1c
Domagala P, Kwiatkowski A, Perkowskaa-Ptasinska A, Wszola M, Panufnik L, Paczek L, et al. Assessment of kidneys procured from expanded criteria donors before transplantation. Transplant Proc 2009;41:2966-69. DOI: https://doi.org/10.1016/j.transproceed.2009.08.004
Kwiatkowski A, Wszola M, Perkowska-PtasinsKa A, Ostrowski K, Domagala P, Fesolowicz S, et al. Influence of preservation method on histopathological lesions of kidney allografts. Ann Transplant 2009;14:10-3.
Wight JP, Chilcott JB, Holmes MW, Brewer N. Pulsatile machine perfusion vs cold storage of kidneys for transplantation: a rapid and systematic review. Clin Transplant 2003;17:293-307. DOI: https://doi.org/10.1034/j.1399-0012.2003.00077.x
Groen H, Moers C, Smits JM, Treckmann J, Monbaliu D, Rahmel A, et al. Long Term Cost-Effectiveness of Hypothermic Machine Perfusion Versus Static Cold Storage in Kidney Transplantation. Am J Transplant 2012;12(7):1824-30. DOI: https://doi.org/10.1111/j.1600-6143.2012.04030.x
Ureña A, Fernández O, Arango A, Rebollo P. Calidad de vida en trasplante renal. En: Libro de comunicaciones del XXI Congreso de la Sociedad Española de Enfermería Nefrológica. Barcelona: HOSPAL; 1996.
Garfield S, Evans R. Machine perfusion cost-effectiveness versus cold storage has been demonstrated; limiting use to marginal donor kidneys unjustified. Transpl Int 2010;23:67-8. DOI: https://doi.org/10.1111/j.1432-2277.2010.01164.x
Lenihan C, O’Kelly P, Mohan P, Little D, Walshe JJ, Kieran NE, et al. MDRD-estimated GFR at one year post-renal transplant is a predictor of long-term graft function. Ren Fail 2008;30:345-52. DOI: https://doi.org/10.1080/08860220801947686
Stratta RJ, Rohr MS, Sundberg AK, Armstrong G, Hairston G, Hartmann E, et al. Increased kidney transplantation utilizing expanded criteria deceased organ donors with results comparable to standard criteria donor transplant. Ann Surg 2004;239:688-95. DOI: https://doi.org/10.1097/01.sla.0000124296.46712.67