Do Pre-Procurement Factors Affect Vascular Resistance During Pulsitile Perfusion of Deceased Donor Kidneys?

H. Kay,¹ S. Gates,² P. Shragg,² L. Stocks,² D. McKay,² R. Steiner.²

¹Rice University, Houston, TX
²Lifesharing OPO of San Diego, University of California at San Diego, San Diego, CA.

Meeting: 2015 American Transplant Congress

Abstract number: B87

Keywords: Cadaveric organs, Kidney transplantation, Pulsatile preservation

Session Information

Session Name: Poster Session B: Kidney and Donor Evaluation/Utilization

Session Type: Poster Session

Date: Sunday, May 3, 2015

Session Time: 5:30pm-6:30pm

Presentation Time: 5:30pm-6:30pm

Location: Exhibit Hall E

Background: Pulsatile perfusion (PP) of explanted deceased donor kidneys can improve early function after transplantation, as compared to static cold flushing and storage. High vascular resistances (VR) during PP may result in a decision not to transplant the organ.

Methods: Because endothelial integrity, small vessel clotting, and vascular contractility may affect VR and be related to terminal donor characteristics, we assessed relationships between pre-procurement laboratory values and donor management parameters on initial and final VRs (IVR and FVR) during PP of 104 pumped kidneys (20 from DCD donors).

Results: Initial and final serum creatinine values were 0.9+/- 0.4 (mean +/- SD) and 0.8 +/- 0.5 mg/dl. IVR was .33 +/-.18 and FVR was .21+/- .11 mmHg/mL/min; PP flow increased from 110 +/-38 to 135 +/-25 ml/min over an average of 7.1 hours of pump time.

IVR and FVR in individual patients were highly correlated (p<.001). Use of neosynephrine in the final 3 hours (n=41) was associated with higher terminal serum creatinine and lower urine volume (p<0.5); terminal dopamine (n= 24) was associated with lower terminal serum HC03- (p<.05). Neither pressor affected IVR or FVR, nor did terminal vasopressin use, terminal serum HCO-, oxygen saturation, PT, PTT, or platelet count.

In unadjusted analysis, increased terminal WBC (14.3 +/- 6.0, range 1.0-30.5K), higher blood pressure, and older donor age correlated (p< .05 or <.01) with increased IVR and FVR . In multivariate analysis, higher donor WBC was associatd with higher IVR and FVR (p<.05), with a marginal effect of older age (p=.06). The relatively small group of DCD kidney donors was younger (49 vs 41) with lower terminal serum creatinine values (0.9 +/- 0.4 vs. 0.6 +/- 0..2 mg/dL) and WBC (15.2 +/- 5 vs 11.5 +/- 3K), but similar IVRs and FVRs (p = .09 and .26). In brain dead donor kidneys, results were similar to those for the group as a whole. Normalizing VRs for kidney mass did not affect results.

Conclusion: Renal vascular resistance in perfused, explanted deceased donor kidneys can be a clinically important variable that appears to be lower in younger donors but is not affected by terminal use of pressors or donor coagulation status. Elevations in donor WBC, suggesting an endothelial effect of systemic inflammation, may increase vascular resistance in perfused kidneys and deserves further study.

To cite this abstract in AMA style:

Kay H, Gates S, Shragg P, Stocks L, McKay D, Steiner R. Do Pre-Procurement Factors Affect Vascular Resistance During Pulsitile Perfusion of Deceased Donor Kidneys? [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/do-pre-procurement-factors-affect-vascular-resistance-during-pulsitile-perfusion-of-deceased-donor-kidneys/. Accessed November 21, 2024.

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