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Objective:An assessment of domestic and foreign literatures regarding the medical expenses of kidney hypothermic machine perfusion(HMP)versus cold storage(CS)to provide guidance for clinical decision-making.Methods:Relevant literatures were retrieved from PubMed, CENTRAL(Cochrane Library), Web of Science, EMBASE, CNKI, Wanfang, etc.The literatures and according data were finally enrolled based on the inclusion and exclusion criteria.The results were reported descriptively.Results:A total of 10 literatures reporting the costs of HMP and CS were included.The results show that HMP can reduce the cost of first hospitalization compared with CS in expanded criteria donor.HMP may also reduce long-term costs compared to CS.The lower cost may be associated with the lower incidence of delayed graft function(DGF).Conclusions:HMP may bring medical and economic benefits to patients.The cost advantage of HMP over CS may be related to the improved quality of donor kidney and a lower incidence of DGF.
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Organ donation after citizen's death has become the main source of organ donation in China. However, the complexity of donor quality and the increasing proportion of expanded criteria donor (ECD) exert significant impact upon the availability of donor kidney and the long-term prognosis of recipients after kidney transplantation. Strengthening the quality maintenance and evaluation of donor kidney is of great significance for improving the quality of donor kidney, increasing the procurement and utilization of donor kidney and prolonging the long-term survival of recipients and kidney allografts. As one of the major approaches of organ preservation, machine perfusion preservation may not only prolong the preservation time and improve the quality of donor kidney, but also play a critical role in the repair and function evaluation of donor kidney. Based on literature review, several hot issues, corresponding treatment strategies and research progress on machine perfusion in the quality maintenance of donor kidney from organ donation after citizen's death were reviewed in this article, aiming to provide reference for selecting the optimal preservation method of donor kidney and enhancing the quality and utilization rate of ECD donor kidney.
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Objective:To explore the prognostic utility of LifePort perfusion parameters plus perfusate biomarkers for predicting delayed graft function(DGF)and recovery time during deceased donor kidney transplantation(KT).Methods:From January 1, 2019 to August 31, 2019, retrospective analysis was performed for clinical data of 113 KT recipients. Based upon whether or not DGF occurred within 3 months, they were divided into two groups of DGF group(20 cases)and non-DGF (93 cases). Two groups were compared using LifePort perfusion parameters, biomarker concentrations, incidence of DGF and kidney recovery time. Statistical analysis was performed.Results:The incidence of DGF was 17.7%(20/113); Multivariate Logistic regression results indicated that terminal resistance(OR 1.879, 95% CI 1.145~3.56)and glutathione S-transferase(GST)(OR 1.62, 95% CI 1.23~2.46)were independent risk factors for DGF; Cox hazard model revealed that terminal resistance was a risk factor for recovery time of renal function(HR=0.823, 95% CI 0.735~0.981). The model combining terminal resistance and GST(AUC=0.888, 95% CI 0.842~0.933)significantly improved the predictive efficacy for DGF as compared with using terminal resistance(AUC=0.756, 95% CI 0.693~0.818)or GST alone(AUC=0.729, 95% CI 0.591~0.806).Conclusions:Combining LifePort perfusion parameters and fluid biomarkers can improve the predictive utility of DGF.
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High-quality donor organs is of significance for the success of organ transplantation. However, standard donors fail to meet the requirements of kidney transplantation due to the increasing quantity of patients with kidney failure. Marginal donor kidneys have been widely applied in clinical practice, which also poses challenges to the existing preservation methods of donor kidneys. Ischemia-reperfusion injury (IRI) is one of the critical factors affecting the early graft function after kidney transplantation. In addition, it exerts harmful effect upon the long-term survival of the graft. Current studies have demonstrated that hemoglobin-based oxygen carrier (HBOC) may reduce the IRI during kidney transplantation, effectively improve the preservation quality and prolong the preservation time of donor kidney. In this article, the research progress on HBOC in kidney transplantation was reviewed, aiming to provide reference for modifying the preservation method of donor kidney, improve the quality of donor kidney and enhance clinical prognosis of the recipients.
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The main purpose of organ preservation in organ transplantation is to maintain tissue and cell activity of donor organs so as to gain time for allocation and transportation of the organ, preparation of the recipient and organization of staff and facilities. The main principles of organ preservation can be divided into normothermic mechanical perfusion and cryopreservation. Cryopreservation is the favourite organ preservation method in clinical practice currently. However, the metabolic activity still exists in donor organs preserved with current cryopreservation technique, which makes the long-term preservation of organs extremely difficult. The supercooling organ preservation is a new type of cryopreservation technology, which greatly prolongs the preservation time of organs. It is expected to become an important organ preservation technique in the future, and it will provide technical support for the establishment of "organ bank".
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Objective To evaluate the clinical effect of hypothermic machine perfusion (HMP) in the storage of renal grafts from deceased donor (DD) with high-risk delayed graft function (DGF). Methods Clinical data of 52 donors with high-risk DGF were collected in this prospective randomized controlled study. Two renal grafts from each donor were randomly divided into the HMP group (n=52) and static cold storage (SCS) group (n=52). In the HMP group, the renal grafts were stored by LifePort under HMP, whereas the renal grafts in the SCS group were preserved in University of Wisconsin solution (UW solution). The incidence of DGF and primary nonfunction (PNF) after renal transplantation was statistically compared between two groups. The recovery of renal graft function, the survival rates of the recipients and renal grafts within postoperative 1 year were observed in two groups. Results The incidence of DGF in the HMP group was 4%(2/52), significantly lower than 17% (9/52) in the SCS group (P < 0.05). No PNF was reported in the HMP group and 1 case of PND was noted in the SCS group, the difference was not statistically significant (P > 0.05). The recovery time of graft function of the recipients in the HMP and SCS groups were (7.2±0.6) d and (7.7±1.0) d with no statistical significance (P > 0.05). In the HMP group, the urine volume of the recipients on the day of operation, postoperative 1 and2 d was significantly larger than that in the SCS group (all P < 0.05). In the HMP group, the levels of serum creatinine at each time point after operation were significantly lower than those in the SCS group (all P < 0.05). The 1-year survival rates of the recipient and kidney were 98.1%, 92.3% and 100%, 96.2% in the HMP and SCS groups with no statistical significance (all P > 0.05). Conclusions HMP can significantly reduce the incidence of DGF after renal transplantation from DD with high-risk DGF and promote the early recovery of graft function.
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Inevitable ischemia-reperfusion injury (IRI) occurred in organ donation after citizen's death often results in delayed graft function (DGF) after renal transplantation. Although the incidence of DGF had reduced to some extent due to continuous hypothermic machine perfusion (HMP) for renal graft using LifePort, DGF of renal graft remains a major clinical problem. In order to further reduce the incidence of DGF after renal transplantation, renal transplant surgeons should fully understand the role of continuous HMP in renal transplantation, continue to conduct more in-depth basic and applied research. This article mainly summarized the effect of continuous HMP on renal transplantation and its research progress.
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INTRODUCCIÓN: La adecuada preservación del aloinjerto previo al trasplante renal es crucial para mantener buenos resultados luego del trasplante. En la actualidad existen dos métodos principales, la perfusión hipotérmica asistida por una máquina y la preservación en frío estático. El objetivo principal de este resumen es comparar ambos sistemas de preservación. MÉTODOS: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos 10 revisiones sistemáticas que en conjunto incluyeron 34 estudios primarios, de los cuales 13 corresponden a ensayos aleatorizados. Concluimos que la preservación mediante perfusión hipotérmica de máquina probablemente disminuye el riesgo de retraso en el funcionamiento del injerto y podría llevar a un leve aumento en la sobrevida del injerto. Sin embargo, no existen diferencias en la sobrevida del paciente entre ambos métodos.
INTRODUCTION: The adequate preservation of the allograft prior to kidney transplant is key for a good outcome after transplantation. Currently, there are two main methods: hypothermic machine perfusion and static cold preservation. The main objective of this summary is to compare both preservation systems. METHODS: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified 10 systematic reviews including 34 primary studies, of which 13 were randomized trials. We concluded preservation by hypothermic machine perfusion probably decreases the risk of delayed graft function and could lead to a slight increase in graft survival. However, there are no differences in patient survival between the two methods.
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Humans , Organ Preservation/methods , Kidney Transplantation/methods , Delayed Graft Function/prevention & control , Perfusion/methods , Randomized Controlled Trials as Topic , Databases, Factual , Cold Temperature , Graft SurvivalABSTRACT
Objective Hypothermic machine perfusion may improve the outcome after transplantation of kidney donated after citizen's death (DCD),but few powered prospective studies have been reported,especially in China.The aim is to compare hypothermic machine perfusion (HMP) with simple cold storage (SCS) in Chinese DCD kidney transplantation,which can offer an optimal method for graft storage with better graft function and survival.Methods 54 kidney pairs from DCD donors were included in this controlled trial in one single center from December 2015 to March 2017.Every two kidneys from each DCD donor wavs randomly assigned to HMP and SCS group.One-year recipient and graft survival rate and endpoints containing the incidence of DGF,the duration of DGF,creatinine reduction ratio (CRR),estimated glomerular filtration rate (Egfr),primary non-function (PNF),acute rejection (AR),toxicity of the immunosuppressive drugs,nosocomial infections and the length of hospital stay were compared between HMP and SCS group.Results One-year recipient survival rate was 98.15 ％ and 96.23％ after DCD transplant in HMP and SCS group,and one-year graft survival rate was 90.74％ and 88.68％,respectively.DGF incidence was 9.62％ in total DCD kidney transplant,8.00％ in HMP group and 11.11％ in SCS group,which was no difference in two groups.22 DCD was from expanded criteria donor (ECD) donation,DGF happened in 15.91％ ECD kidney transplant.However,HMP reduced the incidence of DGF from 27.27％ to 4.55％ after ECD kidney transplant,which was significantly different (x2 =4.247,P =0.039).HMP group acquired significantly lower creatinine level (130.95 ± 46.60) μmol/L than SCS group (181.64 ± 72.94) μmol/L on day 14 after ECD transplant (t =-2.686,P =0.011).Conclusion There was a higher recipient and graft survival rate after DCD and ECD kidney transplant,which would be an effective method to expand donor pool for kidney transplant.HMP was not associated with lower DGF rate in DCD kidney transplant and more rapid recovery in early graft function.However,HMP preservation not only made renal function recover more rapidly but reduced the risk of DGF after ECD kidney transplant.
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Background@#Hypothermic machine perfusion (HMP) is being used more often in cardiac death kidney transplantation; however, the significance of assessing organ quality and predicting delayed graft function (DGF) by HMP parameters is still controversial. Therefore, we used a readily available HMP variable to design a scoring model that can identify the highest risk of DGF and provide the guidance and advice for organ allocation and DCD kidney assessment.@*Methods@#From September 1, 2012 to August 31, 2016, 366 qualified kidneys were randomly assigned to the development and validation cohorts in a 2:1 distribution. The HMP variables of the development cohort served as candidate univariate predictors for DGF. The independent predictors of DGF were identified by multivariate logistic regression analysis with a P < 0.05. According to the odds ratios (ORs) value, each HMP variable was assigned a weighted integer, and the sum of the integers indicated the total risk score for each kidney. The validation cohort was used to verify the accuracy and reliability of the scoring model.@*Results@#HMP duration (OR = 1.165, 95% confidence interval [CI]: 1.008-1.360, P = 0.043), resistance (OR = 2.190, 95% CI: 1.032-10.20, P < 0.001), and flow rate (OR = 0.931, 95% CI: 0.894-0.967, P = 0.011) were the independent predictors of identified DGF. The HMP predictive score ranged from 0 to 14, and there was a clear increase in the incidence of DGF, from the low predictive score group to the very high predictive score group. We formed four increasingly serious risk categories (scores 0-3, 4-7, 8-11, and 12-14) according to the frequency associated with the different risk scores of DGF. The HMP predictive score indicates good discriminative power with a c-statistic of 0.706 in the validation cohort, and it had significantly better prediction value for DGF compared to both terminal flow (P = 0.012) and resistance (P = 0.006).@*Conclusion@#The HMP predictive score is a good noninvasive tool for assessing the quality of DCD kidneys, and it is potentially useful for physicians in making optimal decisions about the organs donated.
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Adult , Female , Humans , Male , Delayed Graft Function , Immunosuppressive Agents , Therapeutic Uses , Kidney Transplantation , Methods , Logistic Models , Multivariate Analysis , Odds Ratio , Organ PreservationABSTRACT
Background@#Vascular resistance and flow rate during hypothermic machine perfusion (HMP) of kidneys is correlated with graft function. We aimed to determine the effects of increasing HMP pressure versus maintaining the initial pressure on kidney transplantation outcomes.@*Methods@#We retrospectively reviewed the data of 76 primary transplantation patients who received HMP-preserved kidneys from 48 donors after cardiac death between September 1, 2013, and August 31, 2015. HMP pressure was increased from 30 to 40 mmHg (1 mmHg = 0.133 kPa) in kidneys with poor flow and/or vascular resistance (increased pressure [IP] group; 36 patients); otherwise, the initial pressure was maintained (constant pressure group; 40 patients). Finally, the clinical characteristics and transplantation outcomes in both groups were assessed.@*Results@#Delayed graft function (DGF) incidence, 1-year allograft, patient survival, kidney function recovery time, and serum creatinine level on day 30 were similar in both groups, with improved flow and resistance in the IP group. Among patients with DGF, kidney function recovery time and DGF duration were ameliorated in the IP group. Multivariate logistic regression analysis revealed that donor hypertension (odds ratio [OR]: 1.43, 95% confidence interval [CI]: 1.02-2.06, P = 0.035), donor terminal serum creatinine (OR: 1.27, 95% CI: 1.06-1.62, P = 0.023), warm ischemic time (OR: 3.45, 95% CI: 1.97-6.37, P = 0.002), and terminal resistance (OR: 3.12, 95% CI: 1.76-6.09, P = 0.012) were independent predictors of DGF. Cox proportional hazards analysis showed that terminal resistance (hazard ratio: 2.06, 95% CI: 1.32-5.16, P = 0.032) significantly affected graft survival.@*Conclusion@#Increased HMP pressure improves graft perfusion but does not affect DGF incidence or 1-year graft survival.
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Adult , Female , Humans , Male , Middle Aged , Allografts , Delayed Graft Function , Hypertension , Kidney Function Tests , Kidney Transplantation , Methods , Logistic Models , Organ Preservation , Retrospective Studies , Tissue DonorsABSTRACT
Objective To evaluate the effect of Lifeport and static cold storage (CS)on preservation of donor kidney. Methods Medline,Embase,Cochrane library,CBMdisc,China National Knowledge Infrastructure,Wanfang database and VIP database were searched by computer,and relevant clinical studies on the effect of Lifeport and CS on preservation of transplant kidney were collected,with the search period from database construction to December 31,2015. According to the inclusion and exclusion criteria,relevant references were selected,quality was evaluated,information was extracted,and risk of bias in the study was evaluated.In addition,Meta analysis was conducted using software Stata 12. Results A total of 16 studies were included with 5 randomized controlled trials (RCT)and 11 retrospective cohort studies (RCS).The results of Meta analysis showed that:compared with Group CS,(1 )for total deceased donor (TDD), incidence of delayed graft function (DGF)decreased in Group Lifeport after transplantation,duration of DGF and average length of stay decreased,and 1﹣year survival rate of kidney increased after operation.The incidence of postoperative acute rejection (AR)and 1﹣year survival rate of patients were similar in two groups.(2)for donor after cardiac death (DCD):postoperative incidence of DGF and average length of stay decreased in Group Lifeport;there was no statistical significance in incidence of primary nonfunction (PNF)and AR,1﹣year survival rate of kidneys and patients between two groups.(3)for expanded criteria donor (ECD):postoperative incidence of PNF decreased and 1﹣year survival rate of kidney increased in Group Lifeport;there was no statistical significance in postoperative incidence of DGF and AR and 1﹣year survival rate of kidney between two groups. Conclusions Application of Lifeport in preservation of donor kidney has certain advantages. However,more high﹣quality studies should be further conducted to verify the study findings due to limited quantity and quality of the study.
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Objective To examine the metabolic variations in liver after 30 min warm ischemic injury,and the effect of hypothermic machine perfusion on the metabolism in rats.Methods 40 SD male rats were randomly divided into 4 groups:Group A,the liver underwent warm ischemia for 0 min and cold storage (CS) for5 h; Group B,the liver was treated by warm ischemia for0 min,CS for4 h and then machine perfusion (MP) for 1 h; Group C,the liver suffered from warm ischemia for 30 min and CS for 5 h; and Group D,the liver was treated by warm ischemia for 30 min plus CS for 4 h plus MP for 1 h.During the MP process,the perfusion resistance index was recorded every 10 min,and the liver glycogen content and malondialdehyde (MDA) value were also detected.Results The hepatic glycogen content decreased after MP treatment,but there was no statistical significance (P ＞ 0.05).No differences on MDA contents was found between Group A and B (P ＞ 0.05),while MDA in Group D was significantly higher than that in Group C (P ＜ 0.05).After hypothermic MP treatment,the liver resistance index value was significantly reduced.Conclusion MP could reduce the resistance index but increase metabolic rate in liver undergoing warm ischemic injury,thus producing more lipid peroxides.