Ex-Vivo Normothermic Perfusion for Assessment of High Risk Deceased Donor Kidneys for Transplantation.
Surgery, University of California-Davis, Sacramento, CA.
Meeting: 2016 American Transplant Congress
Abstract number: C173
Keywords: Donors, Graft failure, marginal, Preservation, Pulsatile preservation
Session Information
Date: Monday, June 13, 2016
Session Name: Poster Session C: Kidney Transplantation: AKI/Preservation/DCD
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
Despite the organ shortage, many procured deceased donor kidneys are deemed too high risk for failure and discarded. Ex-vivo normothermic perfusion (EVNP) may be useful in assessing high risk kidneys. We have begun to utilize EVNP to assess and develop criteria by which high risk discarded kidneys can be deemed transplantable.
From June 2014 to October 2015, 9 kidneys were imported to our center after being turned down by all local and regional centers. We conditionally accepted these organs but after further assessment considered them too high risk due to marginal hypothermic perfusion parameters or biopsy results. These kidneys were placed on EVNP for 3-12 hours, with oxygenated packed red blood cells and nutrition. Assessment was based on appearance, hemodynamic parameters, and urine output (UO).
Reasons for discard were marginal pump parameters (n=6) and biopsy results (n=3). On EVNP, 6 kidneys perfused well, made urine, and in retrospect were deemed transplantable with low risk for failure. Two kidneys appeared viable, had minimal UO, and in retrospect were possibly transplantable with moderate risk for failure. One perfused poorly, with no UO, and was considered non-transplantable. We used unpaired t-test to compare donor factors and perfusion parameters between low and moderate risk kidneys.
| Donor Factors | Kidneys with low risk for failure (mean ± standard error of the mean – SEM, n=6) | Kidneys with moderate risk for failure (mean ±SEM, n=2) | p-value |
| Age (years) | 56.17 ± 3.48 | 51.00 ± 13.00 | 0.76 |
| Kidney donor profile index – KDPI (%) | 80.33 ± 5.35 | 73.50 ± 20.50 | 0.80 |
| Terminal creatinine (mg/dL) | 1.42 ± 0.27 | 2.44 ± 1.89 | 0.68 |
| Cold ischemia time (hours) | 44.00 ± 4.90 | 50.93 ± 12.96 | 0.69 |
| Terminal hypothermic flow (ml/minute) | 73.33 ± 4.13 | 73.50 ± 7.50 | 0.99 |
| Terminal hypothermic renal resistive index | 0.39 ± 0.04 | 0.43 ± 0.05 | 0.64 |
| Terminal EVNP flow (ml/minute) | 353.3 ± 33.83 | 250.0 ± 30.00 | 0.09 |
| Terminal EVNP renal resistive index | 0.21 ± 0.03 | 0.29 ± 0.03 | 0.15 |
| UO (ml/hour) | 125.8 ± 43.14 | 2.25 ± 1.75 | 0.04 |
Many discarded kidneys can be more completely assessed using EVNP and considered for transplantation. Further studies possibly focusing on organ blood flow and function while on EVNP may be important to determine which organs can be transplanted with low risk for failure.
CITATION INFORMATION: Kabagambe S, Palma I, Smolin Y, Boyer T, Palma I, Sageshima J, Santhanakrishnan C, Troppmann C, McVicar J, Perez R. Ex-Vivo Normothermic Perfusion for Assessment of High Risk Deceased Donor Kidneys for Transplantation. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Kabagambe S, Palma I, Smolin Y, Boyer T, Palma I, Sageshima J, Santhanakrishnan C, Troppmann C, McVicar J, Perez R. Ex-Vivo Normothermic Perfusion for Assessment of High Risk Deceased Donor Kidneys for Transplantation. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/ex-vivo-normothermic-perfusion-for-assessment-of-high-risk-deceased-donor-kidneys-for-transplantation/. Accessed March 4, 2021.« Back to 2016 American Transplant Congress