Protection From Second Warm Ischemic Injury Using a Thermal Barrier Bag in Kidney Transplantation

Current status and future perspectives on robot-assisted kidney autotransplantation: A literature review

This review presents the latest insights on robot-assisted kidney autotransplantation (RAKAT). RAKAT is a minimally invasive surgical procedure and represents a promising alternative to conventional laparoscopic nephrectomy followed by open kidney transplantation for the treatment of various complex urological and vascular conditions. RAKAT can be performed either extracorporeally or intracorporeally. Additionally, a single-port approach can be performed through one small incision without the need to reposition the patient. Of 86 patients undergoing RAKAT, 8 (9.3%) developed postoperative > Grade 2 Clavien-Dindo (CD) complications. Although the feasibility of RAKAT was established in 2014, the long-term efficacy and safety along with outcomes of this surgical approach are still being evaluated, and additional studies are needed. With improvements in the technology of RAKAT and as surgeons gain more experience, RAKAT should become increasingly used and further refined, thereby leading to improved surgical outcomes and improved patients' quality of life.

Evaluating a New Device for Reducing Second Warm Ischemia During Organ Transplantation in a Porcine Model of Kidney, Heart, and Pancreas Transplantation

BACKGROUND

Second warm ischemia (SWI) injury between the completion of vascular anastomosis and graft reperfusion has been a longstanding issue in organ transplantation. This type of SWI injury is more severe in transplanted organs more sensitive to temperature changes. This study aimed to present the newly developed OrganPocket, an organ protector made from a proprietary elastomer material, and to demonstrate its efficacy in mitigating SWI injury in clinical kidney transplantation.

METHODS

We used an ex vivo porcine organ model to evaluate OrganPocket. After removal, donor organs were immersed and cryopreserved in an organ preservation solution at 4°C before being placed in an OrganPocket. The organ graft and OrganPocket were held for 30 minutes in a 37°C environment mimicking intra-abdominal conditions while temperatures were recorded. Control organs were evaluated under the same conditions without an OrganPocket. In addition, we tested OrganPocket in an intra-abdominal porcine allograft transplant model.

RESULTS

The control organ group temperature reached ≥16°C after 30 minutes, while the mean core temperature in the OrganPocket organ group remained at no more than 10°C. Despite an SWI time of approximately 30 minutes, the surface organ temperature upon removal of OrganPocket was 20°C. Cardiac grafts also exhibited a normal heartbeat after reperfusion.

CONCLUSIONS

OrganPocket is the world's first device designed to prevent SWI and should also prove useful for heart transplantation.

Effectiveness of Thermal Barrier Bag for Prolonged Vascular Anastomosis in Kidney Transplantation

BACKGROUND

In kidney transplantation (KT), efforts to minimize rewarming and optimize anastomosis time during vascular anastomosis improve graft outcomes. We recently reported the safety and efficacy of a pouch-type thermal barrier bag (TBB) made of elastomer gel to reduce second-warm ischemic injury during vascular anastomosis. We aimed to examine the usefulness of the TBB in prolonged vascular anastomosis in KT performed by young transplant fellows.

METHODS

Young transplant fellows performed KT under the supervision of certified transplant surgeons. The kidney graft was placed inside the TBB with an outlet for vessels and preserved during vascular anastomosis. A non-contact infrared thermometer measured the graft surface temperature before and after vascular anastomosis. After completion of the anastomosis, the TBB was manually slid out of the transplanted kidney and removed before graft reperfusion. Clinical data, including patient characteristics and perioperative variables, were collected. The primary endpoint was the median graft surface temperature at the end of the anastomosis.

RESULTS

Ten living-donor kidney transplant recipients with a median age of 56.5 years (range, 40-69 years) underwent KT procedures performed by young transplant fellows. The median anastomosis time was 53 (43-67) min. At the end of anastomosis, the median graft surface temperature was 17.7°C (16.3-18.3°C); no serious adverse events or delayed graft function were observed.

CONCLUSION

The TBB can keep transplanted kidneys at a low temperature even with prolonged vascular anastomosis time, thus contributing to the functional preservation of transplanted kidneys and stable transplant outcomes.