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Use of ex vivo normothermic machine perfusion after normothermic regional perfusion to salvage a poorly perfused DCD kidney.

Accepted version
Peer-reviewed

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Type

Article

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Authors

Georgiades, Fanourios  ORCID logo  https://orcid.org/0000-0003-0440-2720
Hosgood, Sarah A 
Butler, Andrew J 
Nicholson, Michael L 

Abstract

Normothermic regional perfusion (NRP) and normothermic machine perfusion (NMP) have both been used in the procurement and conditioning of abdominal organs from donation after circulatory death donors with reported improved outcomes for the recipients. Here, we describe an unusual case of a kidney that underwent NMP after NRP. After 2 hours of abdominal NRP, the intra-abdominal organs were cold flushed in situ. The liver and right kidney were well flushed, but the left kidney was poorly flushed. Further attempts to clear the left kidney by flushing on the backtable were unsuccessful, and the kidney was thought to be unsuitable for transplant. The left kidney then underwent a 1-hour period of NMP using a red cell-based perfusate. During NMP, the kidney met previously described quality assurance criteria for transplant with good global perfusion and adequate renal blood flow and urine production. The kidney was transplanted into a suitable recipient who had slow early graft function but did not require dialysis posttransplant. The recipient was discharged 6 days posttransplant, and the serum creatinine level was 160 μmol/L (1.8 mg/dL) at 2 months posttransplant.

Description

Keywords

clinical research/practice, donors and donation: donation after circulatory death (DCD), kidney transplantation/nephrology, organ perfusion and preservation, organ procurement, organ procurement and allocation, organ transplantation in general, Aged, Death, Extracorporeal Circulation, Humans, Kidney, Male, Organ Preservation, Perfusion, Tissue Donors, Tissue Survival, Tissue and Organ Procurement

Journal Title

Am J Transplant

Conference Name

Journal ISSN

1600-6135
1600-6143

Volume Title

19

Publisher

Elsevier BV

Rights

All rights reserved