Normothermic Ex Vivo Kidney Perfusion for Human Kidney Transplantation: First North American Results

Laura I Mazilescu^{1

2

3

4}, Peter Urbanellis^{1

4}, S Joseph Kim^{1

5}, Toru Goto¹, Yuki Noguchi¹, Ana Konvalinka^{1

5

6

7

8}, Trevor W Reichman^{1

4}, Blayne A Sayed^{1

4

9}, Istvan Mucsi^{1

5

7}, Jason Y Lee^{1

10}, Lisa A Robinson^{2

7

11}, Anand Ghanekar^{1

4}, Markus Selzner^{1

4}

Affiliations

¹ Ajmera Transplant Program, Toronto General Hospital, ON, Canada.
² Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada.
³ Department of General, Visceral, and Transplantation Surgery, University Hospital Essen, Essen, Germany.
⁴ Division of General Surgery, University Health Network, Toronto, ON, Canada.
⁵ Division of Nephrology, Department of Medicine, University Health Network, University of Toronto, Toronto, ON, Canada.
⁶ TGHRI, University Health Network, Toronto, ON, Canada.
⁷ Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
⁸ Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
⁹ Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada.
¹⁰ Department of Surgery, Division of Urology, University Health Network, University of Toronto, Toronto, ON, Canada.
¹¹ Program in Cell Biology, The Hospital for Sick Children Research Institute, Toronto, ON, Canada.

PMID: 35238854
DOI: 10.1097/TP.0000000000004098

Normothermic Ex Vivo Kidney Perfusion for Human Kidney Transplantation: First North American Results

Laura I Mazilescu et al. Transplantation. 2022.

. 2022 Sep 1;106(9):1852-1859.

doi: 10.1097/TP.0000000000004098. Epub 2022 Mar 1.

Authors

Affiliations

¹ Ajmera Transplant Program, Toronto General Hospital, ON, Canada.
² Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada.
³ Department of General, Visceral, and Transplantation Surgery, University Hospital Essen, Essen, Germany.
⁴ Division of General Surgery, University Health Network, Toronto, ON, Canada.
⁵ Division of Nephrology, Department of Medicine, University Health Network, University of Toronto, Toronto, ON, Canada.
⁶ TGHRI, University Health Network, Toronto, ON, Canada.
⁷ Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
⁸ Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
⁹ Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada.
¹⁰ Department of Surgery, Division of Urology, University Health Network, University of Toronto, Toronto, ON, Canada.
¹¹ Program in Cell Biology, The Hospital for Sick Children Research Institute, Toronto, ON, Canada.

PMID: 35238854
DOI: 10.1097/TP.0000000000004098

Abstract

Background: Normothermic ex vivo kidney perfusion (NEVKP) has shown promising results for preservation, assessment, and reconditioning of kidney allografts in preclinical studies. Here, we report the first North American safety and feasibility study of deceased donor kidneys grafts transplanted following preservation with NEVKP.

Methods: Outcomes of 13 human kidney grafts that received 1 to 3 h of NEVKP after being transported in an anoxic hypothermic machine perfusion device were compared with a matched control group of 26 grafts that were preserved with anoxic hypothermic machine perfusion alone.

Results: Grafts were perfused for a median of 171 min (range, 44-275 min). The delayed graft function rate in NEVKP versus control patients was 30.8% versus 46.2% ( P = 0.51). During the 1-y follow-up, no differences in postoperative graft function, measured by serum creatinine, necessity for dialysis, and urine production, were found between the study group and the control group. There were no differences in 1 y posttransplantation graft or patient survival between the 2 groups.

Conclusions: Our study demonstrates the safety and feasibility of NEVKP for human deceased donor kidney transplantation. Further studies are warranted to explore how this technology can minimize cold ischemia, improve posttransplant graft function, and assess and repair expanded criteria kidney grafts.

Trial registration: ClinicalTrials.gov NCT03136848.

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Conflict of interest statement

The authors declare no conflicts of interest.

References

1. Andre M, Huang E, Everly M, et al. The UNOS Renal Transplant Registry: review of the last decade. Clin Transpl. 2014;1–12.
1. Wolfe RA, Ashby VB, Milford EL, et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med. 1999;341:1725–1730.
1. Augustine J. Kidney transplant: new opportunities and challenges. Cleve Clin J Med. 2018;85:138–144.
1. Pascual J, Zamora J, Pirsch JD. A systematic review of kidney transplantation from expanded criteria donors. Am J Kidney Dis. 2008;52:553–586.
1. Weber M, Dindo D, Demartines N, et al. Kidney transplantation from donors without a heartbeat. N Engl J Med. 2002;347:248–255.

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Normothermic Ex Vivo Kidney Perfusion for Human Kidney Transplantation: First North American Results

Affiliations

Normothermic Ex Vivo Kidney Perfusion for Human Kidney Transplantation: First North American Results

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

Associated data

LinkOut - more resources

Full Text Sources

Medical