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Meister FA, Czigany Z, Bednarsch J, Böcker J, Amygdalos I, Morales Santana DA, Rietzler K, Moeller M, Tolba R, Boor P, Rohlfs W, Neumann UP, Lurje G. Hypothermic Oxygenated Machine Perfusion of Extended Criteria Kidney Allografts from Brain Dead Donors: Protocol for a Prospective Pilot Study. JMIR Res Protoc 2019; 8:e14622. [PMID: 31613224 PMCID: PMC6913689 DOI: 10.2196/14622] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 08/29/2019] [Accepted: 08/30/2019] [Indexed: 01/13/2023] Open
Abstract
Background Kidney transplantation is the only curative treatment option for end-stage renal disease. The unavailability of adequate organs for transplantation has resulted in a substantial organ shortage. As such, kidney donor allografts that would have previously been deemed unsuitable for transplantation have become an essential organ pool of extended criteria donor allografts that are now routinely being transplanted on a global scale. However, these extended criteria donor allografts are associated with significant graft-related complications. As a result, hypothermic oxygenated machine perfusion (HOPE) has emerged as a powerful, novel technique in organ preservation, and it has recently been tested in preclinical trials in kidney transplantation. In addition, HOPE has already provided promising results in a few clinical series of liver transplantations where the liver was donated after cardiac death. Objective The present trial is an investigator-initiated prospective pilot study on the effects of HOPE on extended criteria donor allografts donated after brain death and used in kidney transplantation. Methods A total of 15 kidney allografts with defined inclusion/exclusion criteria will be submitted to two hours of HOPE via the renal artery before implantation, and are going to be compared to a case-matched group of 30 patients (1:2 matching) who had kidneys transplanted after conventional cold storage. Primary (posttransplant dialysis within 7 days) and secondary (postoperative complications, early graft function, duration of hospital and intensive care unit stay, and six-month graft survival) endpoints will be analyzed within a six-month follow-up period. The extent of ischemia-reperfusion injury will be assessed using kidney tissue, perfusate, and serum samples taken during the perioperative phase of kidney transplantation Results The results of this trial are expected in the first quarter of 2020 and will be presented at national and international scientific meetings and published in international peer-reviewed medical journals. The trial was funded in the third quarter of 2017 and patient enrollment is currently ongoing. Conclusions This prospective study is designed to explore the effects of HOPE on extended criteria donor kidney allografts donated after brain death. The present report represents the preresults phase. Trial Registration Clinicaltrials.gov NCT03378817; https://clinicaltrials.gov/ct2/show/NCT03378817
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Affiliation(s)
- Franziska Alexandra Meister
- Department of Surgery and Transplantation, University Hospital, Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Zoltan Czigany
- Department of Surgery and Transplantation, University Hospital, Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Jan Bednarsch
- Department of Surgery and Transplantation, University Hospital, Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Jörg Böcker
- Department of Surgery and Transplantation, University Hospital, Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Iakovos Amygdalos
- Department of Surgery and Transplantation, University Hospital, Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Daniel Antonio Morales Santana
- Department of Surgery and Transplantation, University Hospital, Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Katharina Rietzler
- Department of Surgery and Transplantation, University Hospital, Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Marcus Moeller
- Division of Nephrology, Department of Medicine II, University Hospital, Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - René Tolba
- Institute for Laboratory Animal Science and Experimental Surgery, University Hospital, Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Peter Boor
- Institute of Pathology, University Hospital, Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Wilko Rohlfs
- Institute of Heat and Mass Transfer, Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Ulf Peter Neumann
- Department of Surgery and Transplantation, University Hospital, Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Georg Lurje
- Department of Surgery and Transplantation, University Hospital, Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
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