Ischemia/reperfusion during normothermic perfusion

Abstract

Introduction: Cold storage of organs for preservation and transplantation is reaching its limits especially with extended criteria for heart beating donors and donation after cardiac death. We will discuss recent findings and perspectives in normothermic kidney preservation.

Methods: A literature review was performed from original articles and syntheses selected by the search engine PubMed. Keywords used were: cold ischemia; warm ischemia, normothermic, organ preservation, preconditioning, organ perfusion.

Results: We identified several ways to improve kidney preservation: Ischemic normothermic preconditioning; Pharmacologic normothermic preconditioning; Ex vivo normothermic reperfusion; Remote ischemic transplantation preconditioning; Ischemic postconditioning. In clinical practice, only uses of ECMO for organ preconditioning or ex vivo normothermic organ perfusion were used.

Conclusion: Promising experimental and clinical results make challenge cold preservation. The most suitable and physiological method seems to be a normothermic perfusion and conservation with autologous oxygenated blood using Extra Corporeal Membrane Oxygenation or Regional Normothermic Circulation.

Keywords: Ex vivo normothermic reperfusion; Ischemic normothermic preconditioning; Ischemic postconditioning; Pharmacologic normothermic preconditioning; Post-conditionnement ischémique; Preconditionnement normothermique ischémique; Preconditionnement normothermique pharmacologique; Remote ischemic transplantation preconditioning; Reperfusion normothermqiue ex-vivo.