Stephen O'Neill1, Gabriel C Oniscu1,2. 1. Edinburgh Transplant Centre, Royal Infirmary of Edinburgh. 2. Department of Clinical Surgery, University of Edinburgh, Edinburgh, UK.
Abstract
PURPOSE OF REVIEW: To summarise recently published studies of donor pretreatment and machine perfusion strategies in kidney transplantation. RECENT FINDINGS: The sparsity of donor pretreatment trials has resulted in the re-analysis of already existing data, and RCTs are urgently needed to reinvigorate this aspect of donor research. Uncontrolled donation after circulatory death kidney transplantation has the highest risk of delayed graft function and graft failure, and recent studies have reported that normothermic regional perfusion improves graft function and survival in this setting. Hypothermic machine perfusion reduces delayed graft function following deceased donor kidney transplantation across donor types but unanswered questions still remain regarding its use. The use of oxygenated hypothermic machine perfusion appears to improve graft function in controlled donation after circulatory death mediated by a reduction in acute rejection. Ex-situ normothermic perfusion is emerging and while technically challenging it may facilitate the delivery of pretreatments. SUMMARY: RCTs are urgently needed to reinvigorate research into donor pretreatment and to establish the place of specific preservation techniques in deceased donor kidney transplantation.
PURPOSE OF REVIEW: To summarise recently published studies of donor pretreatment and machine perfusion strategies in kidney transplantation. RECENT FINDINGS: The sparsity of donor pretreatment trials has resulted in the re-analysis of already existing data, and RCTs are urgently needed to reinvigorate this aspect of donor research. Uncontrolled donation after circulatory death kidney transplantation has the highest risk of delayed graft function and graft failure, and recent studies have reported that normothermic regional perfusion improves graft function and survival in this setting. Hypothermic machine perfusion reduces delayed graft function following deceased donor kidney transplantation across donor types but unanswered questions still remain regarding its use. The use of oxygenated hypothermic machine perfusion appears to improve graft function in controlled donation after circulatory death mediated by a reduction in acute rejection. Ex-situ normothermic perfusion is emerging and while technically challenging it may facilitate the delivery of pretreatments. SUMMARY: RCTs are urgently needed to reinvigorate research into donor pretreatment and to establish the place of specific preservation techniques in deceased donor kidney transplantation.
Authors: Felix Poppelaars; Mariana Gaya da Costa; Bernardo Faria; Siawosh K Eskandari; Marc A Seelen; Jeffrey Damman Journal: J Inflamm Res Date: 2022-04-05
Authors: Thomas Prudhomme; John F Mulvey; Liam A J Young; Benoit Mesnard; Maria Letizia Lo Faro; Ann Etohan Ogbemudia; Fungai Dengu; Peter J Friend; Rutger Ploeg; James P Hunter; Julien Branchereau Journal: Int J Mol Sci Date: 2021-05-13 Impact factor: 5.923