Hypothermic machine perfusion (MP) preservation of kidneys improves outcomes after kidney transplantation in marginal kidneys besides offering prognostic information on graft survival post transplantation. This study aims to evaluate the relationship between anatomy, pathology, donor variables in non ECD (SCD) kidneys, and resistance.
Methods: All kidneys at our institution that were preserved by MP between 1/2008 and 12/2011 were evaluated. Standard criteria donors (SCD kidneys) were studied for perfusion parameters at 15 minute intervals. Initial, average and terminal flow(F in ml/min), resistance (R in ml/min/mmHg),and pump duration in hours,donor variables including age, BMI, gender, race,initial, peak and terminal serum creatinine in mg/dl, hypertension ,diabetes, tobacco use,cause of death were noted. Surgical/anatomical reports were studied to measure kidney size, number of arteries, aortic and renal arterial plaque, cysts and other anomalies. Biopsy reports were evaluated for presence of arterial disease and >10% glomerulosclerosis. SCD kidneys were divided into two groups based on low resistance <0.22 (LR) and high resistance ≥0.22(HR). The two groups were compared using a paired t-test and chi-square analysis. A p value of <0.05 was considered significant.
Results: LR and HR were comparable in BMI, race, gender, cause of death, prevalence of hypertension, diabetes and tobacco use. Initial, 2 hour, 4 hour, 6 hour, average, maximal, terminal flow and resistance were significantly better in LR for equal pump times.
|Low resistance||High resistance|
|Left sided kidney||15||17|
|Kidney width (cm)||5.0±1||5.2±0.9|
|Multiple renal arteries||4/29||2/34|
|Renal arterial/aortic plaque||9/29||24/34*|
Although 1 year graft survival was equal in both groups (100%), creatinine levels were higher in HR (1.1±0.2 v/s 2.08±1.5 mg/dl. P<0.05)
Conclusions: Age and atherosclerotic disease are associated with higher resistance to MP in standard kidneys. Resistance is unaffected by size, arterial anatomy and body habitus. Pump perfusion of SCD kidneys can provide important data on organ quality.
To cite this abstract in AMA style:Patel S, Pankewycz O, Zachariah M, Desai A, Brar J, Mahmood B, Feng L, Said M, Laftavi M. Morphologic Correlates of High Resistance during Kidney Preservation by Hypothermic Machine Perfusion [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/morphologic-correlates-of-high-resistance-during-kidney-preservation-by-hypothermic-machine-perfusion/. Accessed March 19, 2019.
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