S A Hosgood1,2, A D Barlow1,2, J P Hunter1, M L Nicholson1,2. 1. Department of Infection, Immunity and Inflammation, Transplant Group, University of Leicester, Leicester General Hospital, Leicester, UK. 2. Department of Surgery, University of Cambridge. Addenbrooke's Hospital, Cambridge, UK.
Abstract
BACKGROUND: A significant proportion of kidneys procured for transplantation are discarded because of concerns about their suitability. In this study ex vivo normothermic perfusion (EVNP) was used as a quality assessment device before renal transplantation. METHODS: Seventy-four human kidneys deemed unsuitable for transplantation following retrieval underwent 60 min of EVNP with an oxygenated red cell-based solution at 36°C. Receiver operating characteristic (ROC) curves were used to identify thresholds of renal blood flow and urine output. These thresholds and a grading of macroscopic appearance were incorporated into an EVNP assessment score (highest quality, 1; lowest, 5). This was applied to a series of 36 kidneys transplanted after EVNP. RESULTS: In the discarded kidney series, 60 (81 per cent) scored 1-4 and 14 (19 per cent) scored 5. Although none of these kidneys was transplanted, those with a score from 1 to 4 were considered suitable for transplantation. In the 36 transplanted kidneys, the score ranged between 1 and 3 (score 1, 17; score 2, 11; score 3, 8). All of these kidneys were transplanted without any complications or primary non-function. The delayed graft function rate was 6 per cent (1 of 17) in kidneys scoring 1, 0 per cent (0 of 11) in those scoring 2 and 38 per cent (3 of 8) in those scoring 3 (P = 0·024). The mean(s.d.) estimated glomerular filtration rate at 12 months was 51(16), 63(15) and 38(21) ml in kidneys scoring 1, 2 and 3 respectively (P = 0·015). CONCLUSION: EVNP combined with a simple scoring system is an innovative technology for pretransplant assessment of kidney quality and acceptability for transplantation. This study suggests that a high percentage of retrieved kidneys are being discarded unnecessarily.
BACKGROUND: A significant proportion of kidneys procured for transplantation are discarded because of concerns about their suitability. In this study ex vivo normothermic perfusion (EVNP) was used as a quality assessment device before renal transplantation. METHODS: Seventy-four human kidneys deemed unsuitable for transplantation following retrieval underwent 60 min of EVNP with an oxygenated red cell-based solution at 36°C. Receiver operating characteristic (ROC) curves were used to identify thresholds of renal blood flow and urine output. These thresholds and a grading of macroscopic appearance were incorporated into an EVNP assessment score (highest quality, 1; lowest, 5). This was applied to a series of 36 kidneys transplanted after EVNP. RESULTS: In the discarded kidney series, 60 (81 per cent) scored 1-4 and 14 (19 per cent) scored 5. Although none of these kidneys was transplanted, those with a score from 1 to 4 were considered suitable for transplantation. In the 36 transplanted kidneys, the score ranged between 1 and 3 (score 1, 17; score 2, 11; score 3, 8). All of these kidneys were transplanted without any complications or primary non-function. The delayed graft function rate was 6 per cent (1 of 17) in kidneys scoring 1, 0 per cent (0 of 11) in those scoring 2 and 38 per cent (3 of 8) in those scoring 3 (P = 0·024). The mean(s.d.) estimated glomerular filtration rate at 12 months was 51(16), 63(15) and 38(21) ml in kidneys scoring 1, 2 and 3 respectively (P = 0·015). CONCLUSION:EVNP combined with a simple scoring system is an innovative technology for pretransplant assessment of kidney quality and acceptability for transplantation. This study suggests that a high percentage of retrieved kidneys are being discarded unnecessarily.
Authors: Rabindra N Bhattacharjee; Mahms Richard-Mohamed; Qizhi Sun; Aaron Haig; Ghaleb Aboalsamh; Peter Barrett; Richard Mayer; Ibrahim Alhasan; Karen Pineda-Solis; Larry Jiang; Hajed Alharbi; Manujendra Saha; Eric Patterson; Alp Sener; Gediminas Cepinskas; Anthony M Jevnikar; Patrick P W Luke Journal: Transplantation Date: 2018-07 Impact factor: 4.939
Authors: Leonie H Venema; L Leonie van Leeuwen; Rene A Posma; Harry van Goor; Rutger J Ploeg; Patrick Hannaert; Thierry Hauet; Thomas Minor; Henri G D Leuvenink Journal: Transplantation Date: 2022-08-27 Impact factor: 5.385
Authors: Jacqueline L Pasek-Allen; Randall K Wilharm; Zhe Gao; Valerie C Pierre; John C Bischof Journal: J Mater Chem B Date: 2022-05-18 Impact factor: 7.571
Authors: Sarah A Hosgood; Kourosh Saeb-Parsy; Colin Wilson; Christopher Callaghan; Dave Collett; Michael L Nicholson Journal: BMJ Open Date: 2017-01-23 Impact factor: 2.692