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van de Leemkolk FEM, Lo Faro ML, Shaheed S, Mulvey JF, Huurman VAL, Alwayn IPJ, Putter H, Jochmans I, Lindeman JHN, Ploeg RJ. The role of flavin mononucleotide (FMN) as a potentially clinically relevant biomarker to predict the quality of kidney grafts during hypothermic (oxygenated) machine perfusion. PLoS One 2023; 18:e0287713. [PMID: 37352336 PMCID: PMC10289320 DOI: 10.1371/journal.pone.0287713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 05/21/2023] [Indexed: 06/25/2023] Open
Abstract
Hypothermic machine perfusion (HMP) provides preservation superior to cold storage and may allow for organ assessment prior to transplantation. Since flavin mononucleotide (FMN) in perfusate has been proposed as a biomarker of organ quality during HMP of donor livers, the aim of this study was to validate FMN as a biomarker for organ quality in the context of HMP preserved kidneys. Perfusate samples (n = 422) from the paired randomised controlled COPE-COMPARE-trial, comparing HMP with oxygenation (HMPO2) versus standard HMP in kidneys, were used. Fluorescence intensity (FI) was assessed using fluorescence spectroscopy (excitation 450nm; emission 500-600nm) and validated by fluorospectrophotometer and targeted liquid chromatography mass spectrometry (LC-MS/MS). Fluorescence intensity (FI)(ex450;em500-600) increased over time during machine perfusion in both groups (p<0.0001). This increase was similar for both groups (p = 0.83). No correlation, however, was found between FI(ex450;em500-600) and post-transplant outcomes, including day 5 or 7 serum creatinine (p = 0.11; p = 0.16), immediate graft function (p = 0.91), creatinine clearance and biopsy-proven rejection at one year (p = 0.14; p = 0.59). LC-MS/MS validation experiments of samples detected FMN in only one perfusate sample, whilst the majority of samples with the highest fluorescence (n = 37/38, 97.4%) remained negative. In the context of clinical kidney HMP, fluorescence spectroscopy unfortunately appears to be not specific and probably unsuitable for FMN. This study shows that FMN does not classify as a clinically relevant predictive biomarker of kidney graft function after transplantation.
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Affiliation(s)
- Fenna E. M. van de Leemkolk
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
- LUMC Transplant Center, Leiden University Medical Center, Leiden, The Netherlands
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - M. Letizia Lo Faro
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals Trust, Oxford, United Kingdom
| | - Sadr Shaheed
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals Trust, Oxford, United Kingdom
| | - John F. Mulvey
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Volkert A. L. Huurman
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
- LUMC Transplant Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Ian P. J. Alwayn
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
- LUMC Transplant Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Hein Putter
- LUMC Transplant Center, Leiden University Medical Center, Leiden, The Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Ina Jochmans
- Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
- Transplantation Research Group, Lab of Abdominal Transplantation, Department of Microbiology, Immunology, and Transplantation, KU Leuven, Belgium
| | - Jan H. N. Lindeman
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
- LUMC Transplant Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Rutger J. Ploeg
- LUMC Transplant Center, Leiden University Medical Center, Leiden, The Netherlands
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals Trust, Oxford, United Kingdom
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Riella J, Ferreira R, Tabbara MM, Abreu P, Ernani L, Defreitas M, Chandar J, Gaynor JJ, González J, Ciancio G. Retroperitoneal kidney transplantation with liver and native kidney mobilization: a safe technique for pediatric recipients. World J Pediatr 2023; 19:489-501. [PMID: 36474085 PMCID: PMC10149446 DOI: 10.1007/s12519-022-00658-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Pediatric kidney transplant (KT) using larger, deceased or living donor adult kidneys can be challenging in the pediatric population due to limited space in the retroperitoneum. Liver and native kidney (L/NK) mobilization techniques can be used in smaller and younger transplant recipients to aid in retroperitoneal placement of the renal allograft. Here, we compare the clinical outcomes of pediatric retroperitoneal KT with and without L/NK mobilization. METHODS We retrospectively analyzed pediatric renal transplant recipients treated between January 2015 and May 2021. Donor and recipient demographics, intraoperative data, and recipient outcomes were included. Recipients were divided into two groups according to the surgical technique utilized: with L/NK mobilization (Group 1) and without L/NK mobilization (Group 2). Baseline variables were described using frequency distributions for categorical variables and means and standard errors for continuous variables. Tests of association with the likelihood of using L/NK mobilization were performed using standard χ2 tests, t tests, and the log-rank test. RESULTS Forty-six pediatric recipients were evaluated and categorized into Group 1 (n = 26) and Group 2 (n = 20). Recipients in Group 1 were younger (6.7 ± 0.8 years vs. 15. 3 ± 0.7, P < 0.001), shorter (109.5 ± 3.7 vs. 154.2 ± 3.8 cm, P < 0.001) and weighed less (21.4 ± 2.0 vs. 48.6 ± 3.4 kg, P < 0.001) than those in Group 2. Other baseline characteristics did not differ between Groups 1 and 2. One urologic complication was encountered in Group 2; no vascular or surgical complications were observed in either group. Additionally, no stents or drains were used in any of the patients. There were no cases of delayed graft function or graft primary nonfunction. The median follow-up of the study was 24.6 months post-transplant. Two patients developed death-censored graft failure (both in Group 2, P = 0.22), and there was one death with a functioning graft (in Group 2, P = 0.21). CONCLUSIONS Retroperitoneal liver/kidney mobilization is a feasible and safe technique that facilitates implantation of adult kidney allografts into pediatric transplant recipients with no increased risk of developing post-operative complications, graft loss, or mortality.
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Affiliation(s)
- Juliano Riella
- Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, 1801 NW 9Th Ave, 7Th Floor, Miami, FL, 33136, USA
| | - Raphealla Ferreira
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, 1801 NW 9Th Ave, 7Th Floor, Miami, FL, 33136, USA
| | - Marina M Tabbara
- Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
| | - Phillipe Abreu
- Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, 1801 NW 9Th Ave, 7Th Floor, Miami, FL, 33136, USA
| | - Lucas Ernani
- Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, 1801 NW 9Th Ave, 7Th Floor, Miami, FL, 33136, USA
| | - Marissa Defreitas
- Department of Pediatrics, Division of Nephrology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, 1801 NW 9Th Ave, 7Th Floor, Miami, FL, 33136, USA
| | - Jayanthi Chandar
- Department of Pediatrics, Division of Nephrology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, 1801 NW 9Th Ave, 7Th Floor, Miami, FL, 33136, USA
| | - Jeffrey J Gaynor
- Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, 1801 NW 9Th Ave, 7Th Floor, Miami, FL, 33136, USA
| | - Javier González
- Servicio de Urología, Unidad de Trasplante Renal, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Gaetano Ciancio
- Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA.
- Department of Urology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA.
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, 1801 NW 9Th Ave, 7Th Floor, Miami, FL, 33136, USA.
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Savoye E, Legeai C, Branchereau J, Gay S, Riou B, Gaudez F, Veber B, Bruyere F, Cheisson G, Kerforne T, Badet L, Bastien O, Antoine C. Optimal donation of kidney transplants after controlled circulatory death. Am J Transplant 2021; 21:2424-2436. [PMID: 36576341 DOI: 10.1111/ajt.16425] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/27/2020] [Accepted: 11/18/2020] [Indexed: 01/25/2023]
Abstract
Controlled donation after circulatory death (cDCD) is used for "extended criteria" donors with poorer kidney transplant outcomes. The French cDCD program started in 2015 and is characterized by normothermic regional perfusion, hypothermic machine perfusion, and short cold ischemia time. We compared the outcomes of kidney transplantation from cDCD and brain-dead (DBD) donors, matching cDCD and DBD kidney transplants by propensity scoring for donor and recipient characteristics. The matching process retained 442 of 499 cDCD and 809 of 6185 DBD transplantations. The DGF rate was 20% in cDCD recipients compared with 28% in DBD recipients (adjusted relative risk [aRR], 1.43; 95% confidence interval [CI] 1.12-1.82). When DBD transplants were ranked by cold ischemia time and machine perfusion use and compared with cDCD transplants, the aRR of DGF was higher for DBD transplants without machine perfusion, regardless of the cold ischemia time (aRR with cold ischemia time <18 h, 1.57; 95% CI 1.20-2.03, vs aRR with cold ischemia time ≥18 h, 1.79; 95% CI 1.31-2.44). The 1-year graft survival rate was similar in both groups. Early outcome was better for kidney transplants from cDCD than from matched DBD transplants with this French protocol.
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Affiliation(s)
- Emilie Savoye
- Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
| | - Camille Legeai
- Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
| | - Julien Branchereau
- Department of Urology, Nantes University Hospital, University of Nantes, Nantes, France
| | - Samuel Gay
- Intensive Care Unit, Centre Hospitalier Annecy-genevois, Annecy, France
| | - Bruno Riou
- Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Francois Gaudez
- Department of Urology, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Benoit Veber
- Department of Anesthesiology and Critical Care, Rouen University Hospital, Rouen, France
| | | | - Gaelle Cheisson
- Department of Surgical Anesthesia and Intensive Care, South Paris University hospital, Hôpital de Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Thomas Kerforne
- Anesthesia and Intensive Care Unit, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Lionel Badet
- Groupement Hospitalier Edouard Herriot, Service d'urologie chirurgie de la Transplantation, Lyon, France
| | - Olivier Bastien
- Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
| | - Corinne Antoine
- Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
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Carcy R, Cougnon M, Poet M, Durandy M, Sicard A, Counillon L, Blondeau N, Hauet T, Tauc M, F Pisani D. Targeting oxidative stress, a crucial challenge in renal transplantation outcome. Free Radic Biol Med 2021; 169:258-270. [PMID: 33892115 DOI: 10.1016/j.freeradbiomed.2021.04.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/31/2021] [Accepted: 04/15/2021] [Indexed: 02/07/2023]
Abstract
Disorders characterized by ischemia/reperfusion (I/R) are the most common causes of debilitating diseases and death in stroke, cardiovascular ischemia, acute kidney injury or organ transplantation. In the latter example the I/R step defines both the amplitude of the damages to the graft and the functional recovery outcome. During transplantation the kidney is subjected to blood flow arrest followed by a sudden increase in oxygen supply at the time of reperfusion. This essential clinical protocol causes massive oxidative stress which is at the basis of cell death and tissue damage. The involvement of both reactive oxygen species (ROS) and nitric oxides (NO) has been shown to be a major cause of these cellular damages. In fact, in non-physiological situations, these species escape endogenous antioxidant control and dangerously accumulate in cells. In recent years, the objective has been to find clinical and pharmacological treatments to reduce or prevent the appearance of oxidative stress in ischemic pathologies. This is very relevant because, due to the increasing success of organ transplantation, clinicians are required to use limit organs, the preservation of which against oxidative stress is crucial for a better outcome. This review highlights the key actors in oxidative stress which could represent new pharmacological targets.
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Affiliation(s)
- Romain Carcy
- Université Côte d'Azur, CNRS, LP2M, Nice, France; CHU Nice, Hôpital Pasteur 2, Service de Réanimation Polyvalente et Service de Réanimation des Urgences Vitales, Nice, France; Laboratories of Excellence Ion Channel Science and Therapeutics, Nice, France
| | - Marc Cougnon
- Université Côte d'Azur, CNRS, LP2M, Nice, France; Laboratories of Excellence Ion Channel Science and Therapeutics, Nice, France
| | - Mallorie Poet
- Université Côte d'Azur, CNRS, LP2M, Nice, France; Laboratories of Excellence Ion Channel Science and Therapeutics, Nice, France
| | - Manon Durandy
- Université Côte d'Azur, CNRS, LP2M, Nice, France; Laboratories of Excellence Ion Channel Science and Therapeutics, Nice, France
| | - Antoine Sicard
- Université Côte d'Azur, CNRS, LP2M, Nice, France; Laboratories of Excellence Ion Channel Science and Therapeutics, Nice, France; CHU Nice, Hôpital Pasteur 2, Service de Néphrologie-Dialyse-Transplantation, Nice, France; Clinical Research Unit of Université Côte d'Azur (UMR2CA), France
| | - Laurent Counillon
- Université Côte d'Azur, CNRS, LP2M, Nice, France; Laboratories of Excellence Ion Channel Science and Therapeutics, Nice, France
| | | | - Thierry Hauet
- Université de Poitiers, INSERM, IRTOMIT, CHU de Poitiers, La Milétrie, Poitiers, France
| | - Michel Tauc
- Université Côte d'Azur, CNRS, LP2M, Nice, France; Laboratories of Excellence Ion Channel Science and Therapeutics, Nice, France
| | - Didier F Pisani
- Université Côte d'Azur, CNRS, LP2M, Nice, France; Laboratories of Excellence Ion Channel Science and Therapeutics, Nice, France.
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Dufour L, Ferhat M, Robin A, Inal S, Favreau F, Goujon JM, Hauet T, Gombert JM, Herbelin A, Thierry A. [Ischemia-reperfusion injury after kidney transplantation]. Nephrol Ther 2020; 16:388-399. [PMID: 32571740 DOI: 10.1016/j.nephro.2020.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Ischemia-reperfusion injury is an inescapable phenomenon in kidney transplantation. It combines lesional processes of biochemical origin associated with oxydative stress and of immunological origin in connection with the recruitment and activation of innate immunity cells. Histological lesions associate acute tubular necrosis and interstitial œdema, which can progress to interstitial fibrosis. The extent of these lesions depends on donor characteristics (age, expanded criteria donor, etc.) and cold ischemia time. In the short term, ischemia-reperfusion results in delayed recovery of graft function. Cold ischemia time also impacts long-term graft survival. Preclinical models, such as murine and porcine models, have furthered understanding of the pathophysiological mechanisms of ischemia-reperfusion injury. Due to its renal anatomical proximity to humans, the porcine model is relevant to assessment of the molecules administered to a donor or recipient, and also of additives to preservation solutions. Different donor resuscitation and graft perfusion strategies can be studied. In humans, prevention of ischemia-reperfusion injury is a research subject as concerns donor conditioning, additive molecules in preservation solutions, graft reperfusion modalities and choice of the molecules administered to the recipient. Pending significant advances in research, the goal is to achieve the shortest possible cold ischemia time.
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Affiliation(s)
- Léa Dufour
- Service de néphrologie-hémodialyse-transplantation rénale, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France
| | - Maroua Ferhat
- Inserm, U1082 laboratoire Irtomit, 2, rue de la Milétrie, 86021 Poitiers cedex, France
| | - Aurélie Robin
- Inserm, U1082 laboratoire Irtomit, 2, rue de la Milétrie, 86021 Poitiers cedex, France
| | - Sofiane Inal
- Inserm, U1082 laboratoire Irtomit, 2, rue de la Milétrie, 86021 Poitiers cedex, France; Service de biochimie, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France
| | - Frédéric Favreau
- Inserm, U1082 laboratoire Irtomit, 2, rue de la Milétrie, 86021 Poitiers cedex, France
| | - Jean-Michel Goujon
- Service d'anatomopathologie, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France
| | - Thierry Hauet
- Inserm, U1082 laboratoire Irtomit, 2, rue de la Milétrie, 86021 Poitiers cedex, France; Service de biochimie, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France; Fédération hospitalo-universitaire de transplantation Survival Optimization in Organ Transplantation (Support) Tours Poitiers Limoges, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France; Plateforme Infrastructures en biologie, santé et agronomie (Ibisa) Modélisation préclinique - innovation chirurgicale et technologique (Mopict), 86000 Poitiers cedex, France
| | - Jean-Marc Gombert
- Inserm, U1082 laboratoire Irtomit, 2, rue de la Milétrie, 86021 Poitiers cedex, France; Service d'immunologie, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France
| | - André Herbelin
- Inserm, U1082 laboratoire Irtomit, 2, rue de la Milétrie, 86021 Poitiers cedex, France
| | - Antoine Thierry
- Service de néphrologie-hémodialyse-transplantation rénale, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France; Inserm, U1082 laboratoire Irtomit, 2, rue de la Milétrie, 86021 Poitiers cedex, France; Fédération hospitalo-universitaire de transplantation Survival Optimization in Organ Transplantation (Support) Tours Poitiers Limoges, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France.
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Truche AS, Trocme C, Vergnaud S, Janbon B, Giovannini D, Malvezzi P, Moreau-Gaudry X, Rostaing L, Tetaz R. Early Prediction of Graft Outcomes After Kidney Transplantation From Donors After Circulatory Death: Biomarkers and Transplantation Characteristics. Transplant Proc 2019; 51:3234-3243. [PMID: 31732205 DOI: 10.1016/j.transproceed.2019.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 09/26/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND This study aimed to identify transplantation characteristics and biomarkers that predict outcomes for kidney transplant (KT) patients from donors after circulatory death (DCDs). METHODS Consecutive patients receiving a KT from a DCD in our center between 2014 and 2016 were included; the reference population was recipients with a living donor KT. The urinary tubular injury biomarker-to-creatinine ratio and serum lactate dehydrogenase (LDH) were measured at post-transplant days 1 and 3. The primary outcome was the occurrence of delayed graft function (DGF). Descriptive and receiver operating characteristic analyses were performed. RESULTS Forty-one patients were included in the analysis: 15 (36.59%) DCD KTs (9 of which suffered from DGF) and 26 (63.41%) living donor KTs. For the primary endpoint, neutrophil gelatinase-associated lipocalin, N-acetyl-beta-D-glucosaminidase, urinary tubular injury biomarker-to-creatinine ratio, and LDH areas under the curve were 1 and 0.96 (95% confidence interval: 0.84-1.0), 1 and 0.92 (95% confidence interval: 0.73-1.0), respectively. Among the transplant characteristics, only the 30-minute resistive index on the perfusion machine was significantly higher in DCD KTs with DGF vs those without DGF (0.26 mm Hg/mL/min [0.20; 0.32] vs 0.14 mm Hg/mL/min [0.12; 0.16], P = .05). Median 3-month creatinine clearance among DGF DCD KTs was 49 mL/min/1.73 m2 [IQR: 42; 65] and 65 mL/min/1.73 m2 [IQR: 62; 66] among DCD KTs without DGF (P = .22). CONCLUSION In the DCD KT population, clinical and biological markers were identified that provided predictive tools for DGF. Thus, systematic measurement of these biomarkers, particularly LDH, could improve the management of kidney graft recipients' immunosuppressive therapy.
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Affiliation(s)
- Anne-Sophie Truche
- Nephrology Hemodialysis Apheresis, and Kidney Transplantation, Grenoble University Hospital, La Tronche, France; Université Grenoble-Alpes, Grenoble, France
| | - Candice Trocme
- Department of Biochemistry Toxicology and Pharmacology, Grenoble University Hospital, La Tronche, France
| | - Sabrina Vergnaud
- Department of Biochemistry Toxicology and Pharmacology, Grenoble University Hospital, La Tronche, France
| | - Bénédicte Janbon
- Nephrology Hemodialysis Apheresis, and Kidney Transplantation, Grenoble University Hospital, La Tronche, France
| | - Diane Giovannini
- Laboratory of Histopathology, Grenoble University Hospital, La Tronche, France
| | - Paolo Malvezzi
- Nephrology Hemodialysis Apheresis, and Kidney Transplantation, Grenoble University Hospital, La Tronche, France
| | | | - Lionel Rostaing
- Nephrology Hemodialysis Apheresis, and Kidney Transplantation, Grenoble University Hospital, La Tronche, France; Université Grenoble-Alpes, Grenoble, France.
| | - Rachel Tetaz
- Nephrology Hemodialysis Apheresis, and Kidney Transplantation, Grenoble University Hospital, La Tronche, France
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Samoylova ML, Nash A, Kuchibhatla M, Barbas AS, Brennan TV. Machine perfusion of donor kidneys may reduce graft rejection. Clin Transplant 2019; 33:e13716. [DOI: 10.1111/ctr.13716] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 09/08/2019] [Accepted: 09/10/2019] [Indexed: 11/30/2022]
Affiliation(s)
| | - Amanda Nash
- Department of Surgery Duke University Medical Center Durham North Carolina
| | | | - Andrew S. Barbas
- Department of Surgery Duke University Medical Center Durham North Carolina
| | - Todd V. Brennan
- Department of Surgery Cedars‐Sinai Medical Center Los Angeles California
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8
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Savoye E, Macher MA, Videcoq M, Gatault P, Hazzan M, Abboud I, Thierry A, Bertrand D, Drouin S, Sayegh J, Barrou B, Badet L, Bastien O, Huot O, Lamotte C, Logerot H, Legeai C, Antoine C. Evaluation of outcomes in renal transplantation with hypothermic machine perfusion for the preservation of kidneys from expanded criteria donors. Clin Transplant 2019; 33:e13536. [PMID: 30869162 DOI: 10.1111/ctr.13536] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 02/19/2019] [Accepted: 03/06/2019] [Indexed: 01/10/2023]
Abstract
In 2012, an expert working group from the French Transplant Health Authority recommended the use of hypothermic machine perfusion (HMP) to improve kidney preservation and transplant outcomes from expanded criteria donors, deceased after brain death. This study compares HMP and cold storage (CS) effects on delayed graft function (DGF) and transplant outcomes. We identified 4,316 kidney transplants from expanded criteria donors (2011-2014) in France through the French Transplant Registry. DGF occurrence was analyzed with a logistic regression, excluding preemptive transplants. One-year graft failure was analyzed with a Cox regression. A subpopulation of 66 paired kidneys was identified: one preserved by HMP and the other by CS from the same donor. Kidneys preserved by HMP (801) vs CS (3515) were associated with more frequent recipient comorbidities and older donors and recipients. HMP had a protective effect against DGF (24% in HMP group and 38% in CS group, OR = 0.49 [0.40-0.60]). Results were similar in the paired kidneys (OR = 0.23 [0.04-0.57]). HMP use decreased risk for 1-year graft failure (HR = 0.77 [0.60-0.99]). Initial hospital stays were shorter in the HMP group (P < 0.001). Our results confirm the reduction in DGF occurrence among expanded criteria donors kidneys preserved by HMP.
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Affiliation(s)
- Emilie Savoye
- Agence de la Biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
| | - Marie-Alice Macher
- Agence de la Biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
| | | | | | | | | | | | | | | | | | | | - Lionel Badet
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Olivier Bastien
- Agence de la Biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
| | - Olivier Huot
- Agence de la Biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
| | - Christian Lamotte
- Agence de la Biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
| | - Hélène Logerot
- Agence de la Biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
| | - Camille Legeai
- Agence de la Biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
| | - Corinne Antoine
- Agence de la Biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
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Patel SVB, Sener A, Bhattacharjee RN, Luke PPW. Machine preservation of donor kidneys in transplantation. Transl Androl Urol 2019; 8:118-125. [PMID: 31080771 DOI: 10.21037/tau.2019.03.06] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
With increasing demands for 'less than ideal' kidneys for transplantation, machine perfusion of kidneys has been utilized to improve the preservation of kidneys during storage. Hypothermic machine perfusion (HMP) of renal allografts has been shown to reduce delayed graft function rates in both expanded criteria and donation after cardiac death renal allografts. However, the beneficial impact upon long-term graft function is unclear. There has been emerging evidence that both subnormothermic (room temperature) and normothermic machine perfusion (NMP) of allografts have beneficial effects with regards to early graft function, survival and injury in pre-clinical and early clinical studies. Additionally, machine perfusion allows functional assessment of the organ prior to transplantation. Ultimately, the greatest benefit of machine perfusion may be the ability to treat the organ with agents to protect the graft against ischemia reperfusion injury, while awaiting transplantation.
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Affiliation(s)
- Sanjay V B Patel
- Multi Organ Transplant Program, London Health Sciences Centre, London, ON, Canada.,Department of Surgery, Western University, London, ON, Canada.,Matthew Mailing Centre for Translational Transplantation Studies, London, ON, Canada
| | - Alp Sener
- Multi Organ Transplant Program, London Health Sciences Centre, London, ON, Canada.,Department of Surgery, Western University, London, ON, Canada.,Matthew Mailing Centre for Translational Transplantation Studies, London, ON, Canada
| | - Rabindra N Bhattacharjee
- Multi Organ Transplant Program, London Health Sciences Centre, London, ON, Canada.,Matthew Mailing Centre for Translational Transplantation Studies, London, ON, Canada
| | - Patrick P W Luke
- Multi Organ Transplant Program, London Health Sciences Centre, London, ON, Canada.,Department of Surgery, Western University, London, ON, Canada.,Matthew Mailing Centre for Translational Transplantation Studies, London, ON, Canada
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10
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Ding CG, Tian PX, Ding XM, Xiang HL, Li Y, Tian XH, Han F, Tai QH, Liu QL, Zheng J, Xue WJ. Beneficial Effect of Moderately Increasing Hypothermic Machine Perfusion Pressure on Donor after Cardiac Death Renal Transplantation. Chin Med J (Engl) 2019; 131:2676-2682. [PMID: 30425194 PMCID: PMC6247599 DOI: 10.4103/0366-6999.245274] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background: Vascular resistance and flow rate during hypothermic machine perfusion (HMP) of kidneys is correlated with graft function. We aimed to determine the effects of increasing HMP pressure versus maintaining the initial pressure on kidney transplantation outcomes. Methods: We retrospectively reviewed the data of 76 primary transplantation patients who received HMP-preserved kidneys from 48 donors after cardiac death between September 1, 2013, and August 31, 2015. HMP pressure was increased from 30 to 40 mmHg (1 mmHg = 0.133 kPa) in kidneys with poor flow and/or vascular resistance (increased pressure [IP] group; 36 patients); otherwise, the initial pressure was maintained (constant pressure group; 40 patients). Finally, the clinical characteristics and transplantation outcomes in both groups were assessed. Results: Delayed graft function (DGF) incidence, 1-year allograft, patient survival, kidney function recovery time, and serum creatinine level on day 30 were similar in both groups, with improved flow and resistance in the IP group. Among patients with DGF, kidney function recovery time and DGF duration were ameliorated in the IP group. Multivariate logistic regression analysis revealed that donor hypertension (odds ratio [OR]: 1.43, 95% confidence interval [CI]: 1.02–2.06, P = 0.035), donor terminal serum creatinine (OR: 1.27, 95% CI: 1.06–1.62, P = 0.023), warm ischemic time (OR: 3.45, 95% CI: 1.97–6.37, P = 0.002), and terminal resistance (OR: 3.12, 95% CI: 1.76–6.09, P = 0.012) were independent predictors of DGF. Cox proportional hazards analysis showed that terminal resistance (hazard ratio: 2.06, 95% CI: 1.32–5.16, P = 0.032) significantly affected graft survival. Conclusion: Increased HMP pressure improves graft perfusion but does not affect DGF incidence or 1-year graft survival.
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Affiliation(s)
- Chen-Guang Ding
- Department of Renal Transplantation, Nephropathy Hospital, The First Affiliated Hospital of Xi'an Jiaotong University; Institute of Organ Transplantation, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Pu-Xun Tian
- Department of Renal Transplantation, Nephropathy Hospital, The First Affiliated Hospital of Xi'an Jiaotong University; Institute of Organ Transplantation, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Xiao-Ming Ding
- Department of Renal Transplantation, Nephropathy Hospital, The First Affiliated Hospital of Xi'an Jiaotong University; Institute of Organ Transplantation, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - He-Li Xiang
- Department of Renal Transplantation, Nephropathy Hospital, The First Affiliated Hospital of Xi'an Jiaotong University; Institute of Organ Transplantation, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Yang Li
- Department of Renal Transplantation, Nephropathy Hospital, The First Affiliated Hospital of Xi'an Jiaotong University; Institute of Organ Transplantation, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Xiao-Hui Tian
- Department of Renal Transplantation, Nephropathy Hospital, The First Affiliated Hospital of Xi'an Jiaotong University; Institute of Organ Transplantation, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Feng Han
- Department of Renal Transplantation, Nephropathy Hospital, The First Affiliated Hospital of Xi'an Jiaotong University; Institute of Organ Transplantation, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Qian-Hui Tai
- Department of Renal Transplantation, Nephropathy Hospital, The First Affiliated Hospital of Xi'an Jiaotong University; Institute of Organ Transplantation, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Qian-Long Liu
- Department of Renal Transplantation, Nephropathy Hospital, The First Affiliated Hospital of Xi'an Jiaotong University; Institute of Organ Transplantation, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Jin Zheng
- Department of Renal Transplantation, Nephropathy Hospital, The First Affiliated Hospital of Xi'an Jiaotong University; Institute of Organ Transplantation, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Wu-Jun Xue
- Department of Renal Transplantation, Nephropathy Hospital, The First Affiliated Hospital of Xi'an Jiaotong University; Institute of Organ Transplantation, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
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11
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Ding CG, Li Y, Tian XH, Hu XJ, Tian PX, Ding XM, Xiang HL, Zheng J, Xue WJ. Predictive Score Model for Delayed Graft Function Based on Hypothermic Machine Perfusion Variables in Kidney Transplantation. Chin Med J (Engl) 2019; 131:2651-2657. [PMID: 30425191 PMCID: PMC6247597 DOI: 10.4103/0366-6999.245278] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Hypothermic machine perfusion (HMP) is being used more often in cardiac death kidney transplantation; however, the significance of assessing organ quality and predicting delayed graft function (DGF) by HMP parameters is still controversial. Therefore, we used a readily available HMP variable to design a scoring model that can identify the highest risk of DGF and provide the guidance and advice for organ allocation and DCD kidney assessment. Methods: From September 1, 2012 to August 31, 2016, 366 qualified kidneys were randomly assigned to the development and validation cohorts in a 2:1 distribution. The HMP variables of the development cohort served as candidate univariate predictors for DGF. The independent predictors of DGF were identified by multivariate logistic regression analysis with a P < 0.05. According to the odds ratios (ORs) value, each HMP variable was assigned a weighted integer, and the sum of the integers indicated the total risk score for each kidney. The validation cohort was used to verify the accuracy and reliability of the scoring model. Results: HMP duration (OR = 1.165, 95% confidence interval [CI ]: 1.008–1.360, P = 0.043), resistance (OR = 2.190, 95% CI: 1.032–10.20, P < 0.001), and flow rate (OR = 0.931, 95% CI: 0.894–0.967, P = 0.011) were the independent predictors of identified DGF. The HMP predictive score ranged from 0 to 14, and there was a clear increase in the incidence of DGF, from the low predictive score group to the very high predictive score group. We formed four increasingly serious risk categories (scores 0–3, 4–7, 8–11, and 12–14) according to the frequency associated with the different risk scores of DGF. The HMP predictive score indicates good discriminative power with a c-statistic of 0.706 in the validation cohort, and it had significantly better prediction value for DGF compared to both terminal flow (P = 0.012) and resistance (P = 0.006). Conclusion: The HMP predictive score is a good noninvasive tool for assessing the quality of DCD kidneys, and it is potentially useful for physicians in making optimal decisions about the organs donated.
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Affiliation(s)
- Chen-Guang Ding
- Department of Kidney Transplantation, Nephropathy Hospital, The First Affiliated Hospital of Xi'an Jiaotong University; Institute of Organ Transplantation, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Yang Li
- Department of Kidney Transplantation, Nephropathy Hospital, The First Affiliated Hospital of Xi'an Jiaotong University; Institute of Organ Transplantation, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Xiao-Hui Tian
- Department of Kidney Transplantation, Nephropathy Hospital, The First Affiliated Hospital of Xi'an Jiaotong University; Institute of Organ Transplantation, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Xiao-Jun Hu
- Department of Kidney Transplantation, Nephropathy Hospital, The First Affiliated Hospital of Xi'an Jiaotong University; Institute of Organ Transplantation, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Pu-Xu Tian
- Department of Kidney Transplantation, Nephropathy Hospital, The First Affiliated Hospital of Xi'an Jiaotong University; Institute of Organ Transplantation, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Xiao-Ming Ding
- Department of Kidney Transplantation, Nephropathy Hospital, The First Affiliated Hospital of Xi'an Jiaotong University; Institute of Organ Transplantation, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - He-Li Xiang
- Department of Kidney Transplantation, Nephropathy Hospital, The First Affiliated Hospital of Xi'an Jiaotong University; Institute of Organ Transplantation, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Jin Zheng
- Department of Kidney Transplantation, Nephropathy Hospital, The First Affiliated Hospital of Xi'an Jiaotong University; Institute of Organ Transplantation, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Wu-Jun Xue
- Department of Kidney Transplantation, Nephropathy Hospital, The First Affiliated Hospital of Xi'an Jiaotong University; Institute of Organ Transplantation, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
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12
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Cooper M, Formica R, Friedewald J, Hirose R, O’Connor K, Mohan S, Schold J, Axelrod D, Pastan S. Report of National Kidney Foundation Consensus Conference to Decrease Kidney Discards. Clin Transplant 2018; 33:e13419. [DOI: 10.1111/ctr.13419] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 09/29/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Matthew Cooper
- Medstar Georgetown Transplant Institute; Georgetown University; Washington District of Columbia
| | - Richard Formica
- Department of Medicine, Section of Nephrology; Yale School of Medicine; New Haven Connecticut
| | - John Friedewald
- Northwestern University Comprehensive Transplant Center; Chicago Illinois
| | - Ryutaro Hirose
- Department of Surgery; University of California San Francisco; San Francisco California
| | | | - Sumit Mohan
- Division of Nephrology, Department of Medicine; Vagelos College of Physicians & Surgeons, Columbia University; New York New York
- Department of Epidemiology, Mailman School of Public Health; Columbia University; New York New York
| | - Jesse Schold
- Department of Quantitative Health Sciences; Cleveland Clinic; Cleveland Ohio
| | - David Axelrod
- Department of Surgery; Lahey Hospital and Medical Center; Burlington Massachusetts
| | - Stephen Pastan
- Renal Division, Department of Medicine; Emory University School of Medicine; Atlanta Georgia
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13
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Does Rabbit Antithymocyte Globulin (Thymoglobuline®) Have a Role in Avoiding Delayed Graft Function in the Modern Era of Kidney Transplantation? J Transplant 2018; 2018:4524837. [PMID: 30112193 PMCID: PMC6077603 DOI: 10.1155/2018/4524837] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 06/20/2018] [Indexed: 12/16/2022] Open
Abstract
Delayed graft function (DGF) increases the risk of graft loss by up to 40%, and recent developments in kidney donation have increased the risk of its occurrence. Lowering the risk of DGF, however, is challenging due to a complicated etiology in which ischemia-reperfusion injury (IRI) leads to acute tubular necrosis. Among various strategies explored, the choice of induction therapy is one consideration. Rabbit antithymocyte globulin (rATG [Thymoglobuline]) has complex immunomodulatory effects that are relevant to DGF. In addition to a rapid and profound T-cell depletion, rATG inhibits leukocyte migration and adhesion. Experimental studies of rATG have demonstrated attenuated IRI-related tissue damage in reperfused tissues, consistent with histological evidence from transplant recipients. Starting rATG intraoperatively instead of postoperatively can improve kidney graft function and reduce the incidence of DGF. rATG is effective in preventing acute rejection in kidney transplant recipients at high immunological risk, supporting delayed calcineurin inhibitor (CNI) introduction which protects the graft from early insults. A reduced rate of DGF has been reported with rATG (started intraoperatively) and delayed CNI therapy compared to IL-2RA induction with immediate CNI in patients at high immunological risk, but not in lower-risk patients. Overall, induction with rATG induction is the preferred choice for supporting delayed introduction of CNI therapy to avoid DGF in high-risk patients but shows no benefit versus IL-2RA in lower-risk individuals. Evidence is growing that intraoperative rATG ameliorates IRI, and it seems reasonable to routinely start rATG before reperfusion.
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14
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Sandal S, Luo X, Massie AB, Paraskevas S, Cantarovich M, Segev DL. Machine perfusion and long-term kidney transplant recipient outcomes across allograft risk strata. Nephrol Dial Transplant 2018; 33:1251-1259. [PMID: 29474675 PMCID: PMC6030984 DOI: 10.1093/ndt/gfy010] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 12/27/2017] [Indexed: 12/22/2022] Open
Abstract
Background The use of machine perfusion (MP) in kidney transplantation lowers delayed graft function (DGF) and improves 1-year graft survival in some, but not all, grafts. These associations have not been explored in grafts stratified by the Kidney Donor Profile index (KDPI). Methods We analyzed 78 207 deceased-donor recipients using the Scientific Registry of Transplant Recipients data from 2006 to 2013. The cohort was stratified using the standard criteria donor/expanded criteria donor (ECD)/donation after cardiac death (DCD)/donation after brain death (DBD) classification and the KDPI scores. In each subgroup, MP use was compared with cold storage. Results The overall DGF rate was 25.4% and MP use was associated with significantly lower DGF in all but the ECD-DCD donor subgroup. Using the donor source classification, the use of MP did not decrease death-censored graft failure (DCGF), except in the ECD-DCD subgroup from 0 to 1 year {adjusted hazard ratio [aHR] 0.56 [95% confidence interval (CI) 0.32-0.98]}. In the ECD-DBD subgroup, higher DCGF from 1 to 5 years was noted [aHR 1.15 (95% CI 1.01-1.31)]. Also, MP did not lower all-cause graft failure except in the ECD-DCD subgroup from 0 to 1 year [aHR = 0.59 (95% CI 0.38-0.91)]. Using the KDPI classification, MP did not lower DCGF or all-cause graft failure, but in the ≤70 subgroup, higher DCGF [aHR 1.16 (95% CI 1.05-1.27)] and higher all-cause graft failure [aHR 1.10 (95% CI 1.02-1.18)] was noted. Lastly, MP was not associated with mortality in any subgroup. Conclusions Overall, MP did not lower DCGF. Neither classification better risk-stratified kidneys that have superior graft survival with MP. We question their widespread use in all allografts as an ideal approach to organ preservation.
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Affiliation(s)
- Shaifali Sandal
- Department of Medicine, Divisions of Nephrology and Multi-Organ Transplant Program, McGill University Health Centre, Montreal, QC, Canada
| | - Xun Luo
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Allan B Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Steven Paraskevas
- Department of Surgery, Division of Multi-Organ Transplant Program, McGill University Health Centre, Montreal, QC, Canada
| | - Marcelo Cantarovich
- Department of Medicine, Divisions of Nephrology and Multi-Organ Transplant Program, McGill University Health Centre, Montreal, QC, Canada
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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15
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Patel K, Nath J, Hodson J, Inston N, Ready A. Outcomes of donation after circulatory death kidneys undergoing hypothermic machine perfusion following static cold storage: A UK population-based cohort study. Am J Transplant 2018; 18:1408-1414. [PMID: 29136348 DOI: 10.1111/ajt.14587] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 10/24/2017] [Accepted: 11/08/2017] [Indexed: 01/25/2023]
Abstract
Evidence is currently lacking regarding the outcomes of kidneys undergoing hypothermic machine perfusion (HMP) in patients in the United Kingdom. Using the National Health Service Blood and Transplant database, the authors compared outcomes for recipients of single-organ donation after circulatory death (DCD) kidneys preserved with HMP with those preserved using only static cold storage (SCS). Between 2007 and 2015, HMP was used in 19.1% (864/4,529) of kidneys. Rates of delayed graft function (DGF) were significantly lower in organs preserved with HMP than for organs preserved with SCS (34.2% vs 42.0%, P < .001), despite a slightly longer cold ischemic time (median: 14.8 vs 14.1 hours, P < .001). Multivariable analysis found the effect of preservation modality to remain significant, with HMP organs having a significantly lower rate of DGF (odds ratio 0.65, 95% confidence interval 0.53-0.80, P < .001) and significantly shorter times to DGF resolution (average: 6.1 vs 7.4 days, P = .003) than SCS organs. The patient (P = .313) and graft (P = .263) survival rates were similar in the 2 preservation groups. HMP was associated with a marginal functional benefit in 1-year creatinine values (P = .044), with adjusted averages of 1.36 mg/dL (HMP) versus 1.40 mg/dL (SCS). This study supports the use of HMP and aids decision-making over its instigation, which may improve short-term patient outcomes.
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Affiliation(s)
- Kamlesh Patel
- Department of Renal Surgery, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.,Institute of Metabolism and Systems Research, School of Medical and Dental Science, University of Birmingham, Birmingham, UK
| | - Jay Nath
- Department of Renal Surgery, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.,Institute of Metabolism and Systems Research, School of Medical and Dental Science, University of Birmingham, Birmingham, UK
| | - James Hodson
- Institute of Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Nicholas Inston
- Department of Renal Surgery, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Andrew Ready
- Department of Renal Surgery, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
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16
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Bissolati M, Gazzetta PG, Caldara R, Guarneri G, Adamenko O, Giannone F, Mazza M, Maggi G, Tomanin D, Rosati R, Secchi A, Socci C. Renal Resistance Trend During Hypothermic Machine Perfusion Is More Predictive of Postoperative Outcome Than Biopsy Score: Preliminary Experience in 35 Consecutive Kidney Transplantations. Artif Organs 2018; 42:714-722. [DOI: 10.1111/aor.13117] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 12/18/2017] [Accepted: 12/28/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Massimiliano Bissolati
- Transplant Surgery Unit, Department of Surgery; San Raffaele Scientific Institute; Milan Italy
| | - Paolo Giovanni Gazzetta
- Transplant Surgery Unit, Department of Surgery; San Raffaele Scientific Institute; Milan Italy
| | - Rossana Caldara
- Transplant Medicine; San Raffaele Scientific Institute; Milan Italy
| | - Giovanni Guarneri
- Transplant Surgery Unit, Department of Surgery; San Raffaele Scientific Institute; Milan Italy
| | - Olga Adamenko
- Transplant Surgery Unit, Department of Surgery; San Raffaele Scientific Institute; Milan Italy
| | - Fabio Giannone
- Transplant Surgery Unit, Department of Surgery; San Raffaele Scientific Institute; Milan Italy
| | - Michele Mazza
- Transplant Surgery Unit, Department of Surgery; San Raffaele Scientific Institute; Milan Italy
| | - Giulia Maggi
- Transplant Surgery Unit, Department of Surgery; San Raffaele Scientific Institute; Milan Italy
| | - Deborah Tomanin
- Transplant Surgery Unit, Department of Surgery; San Raffaele Scientific Institute; Milan Italy
| | - Riccardo Rosati
- Transplant Surgery Unit, Department of Surgery; San Raffaele Scientific Institute; Milan Italy
| | - Antonio Secchi
- Transplant Medicine; San Raffaele Scientific Institute; Milan Italy
| | - Carlo Socci
- Transplant Surgery Unit, Department of Surgery; San Raffaele Scientific Institute; Milan Italy
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17
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Sampaio MS, Chopra B, Tang A, Sureshkumar KK. Impact of cold ischemia time on the outcomes of kidneys with Kidney Donor Profile Index ≥85%: mate kidney analysis - a retrospective study. Transpl Int 2018; 31:729-738. [PMID: 29368361 DOI: 10.1111/tri.13121] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 09/15/2017] [Accepted: 01/19/2018] [Indexed: 12/17/2022]
Abstract
The new kidney allocation system recommends local and regional sharing of deceased donor kidneys (DDK) with 86-100% Kidney Donor Profile Index (KDPI) to minimize discard. Regional sharing can increase cold ischemia time (CIT) which may negatively impact transplant outcomes. Using a same donor mate kidney model, we aimed to define a CIT that should be targeted to optimize outcomes. Using Organ Procurement and Transplant Network/United Network for Organ Sharing database, we identified recipients of DDK from 2000 to 2013 with ≥85% KDPI. From this cohort, three groups of mate kidney recipients were identified based on CIT: group 1 (≥24 vs. ≥12 to <24 h), group 2 (≥24 vs. <12 h), and group 3 (≥12 to <24 vs. <12 h). Adjusted delayed graft function (DGF), and graft and patient survivals were compared for mate kidneys. DGF risk was significantly lower for patients with CIT <12 vs. ≥24 h in group 2 (adjusted OR: 0.25, 95% CI: 0.12-0.57, P < 0.001) while trending lower for CIT ≥12 to <24 vs. ≥24 h in group 1 (adjusted OR: 0.78, 95% CI: 0.59-1.03, P = 0.08) and CIT <12 vs. ≥12 to <24 h in group 3 (adjusted OR: 0.74, 95% CI: 0.55-1.0, P = 0.05). Adjusted graft and patient survivals were similar between mate kidneys in all groups. Minimizing CIT improves outcomes with regional sharing of marginal kidneys.
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Affiliation(s)
- Marcelo S Sampaio
- Department of Medicine, Allegheny Health Network, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Bhavna Chopra
- Department of Medicine, Allegheny Health Network, Allegheny General Hospital, Pittsburgh, PA, USA.,Division of Nephrology and Hypertension, Allegheny Health Network, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Amy Tang
- Biostatistics, Allegheny Health Network, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Kalathil K Sureshkumar
- Department of Medicine, Allegheny Health Network, Allegheny General Hospital, Pittsburgh, PA, USA.,Division of Nephrology and Hypertension, Allegheny Health Network, Allegheny General Hospital, Pittsburgh, PA, USA
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18
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Matos ACC, Requiao Moura LR, Borrelli M, Nogueira M, Clarizia G, Ongaro P, Durão MS, Pacheco-Silva A. Impact of machine perfusion after long static cold storage on delayed graft function incidence and duration and time to hospital discharge. Clin Transplant 2017; 32. [PMID: 28972665 DOI: 10.1111/ctr.13130] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2017] [Indexed: 11/30/2022]
Abstract
Delayed graft function (DGF) is very high in our center (70%-80%), and we usually receive a kidney for transplant after more than 22 hours of static cold ischemia time (CIT). Also, there is an inadequate care of the donors, contributing to a high rate of DGF. We decided to test whether machine perfusion (MP) after a CIT improved the outcome of our transplant patients. We analyzed the incidence of DGF, its duration, and the length of hospital stay (LOS) in patients who received a kidney preserved with MP after a CIT (hybrid perfusion-HP). We included 54 deceased donors kidneys preserved with HP transplanted from Feb/13 to Jul/14, and compared them to 101 kidney transplants preserved by static cold storage (CS) from Nov/08 to May/12. The median pumping time was 11 hours. DGF incidence was 61.1% vs 79.2% (P = .02), median DGF duration was 5 vs 11 days (P < .001), and median LOS was 13 vs 18 days (P < .011), for the HP compared to CS group. The observed reduction of DGF with machine perfusion did not occur in donors over 50 years old. In the multivariate analysis, risk factors for DGF, adjusted for CIT, were donor age (OR, 1.04; P = .005) and the absence of use of MP (OR, 1.54; P = .051). In conclusion, the use of HP contributed to faster recovery of renal function and to a shorter length of hospital stay.
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Affiliation(s)
- Ana Cristina C Matos
- Renal Transplantation Division, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Milton Borrelli
- Renal Transplantation Division, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Mario Nogueira
- Renal Transplantation Division, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Gabriela Clarizia
- Renal Transplantation Division, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Paula Ongaro
- Renal Transplantation Division, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Marcelino Souza Durão
- Renal Transplantation Division, Hospital Israelita Albert Einstein, São Paulo, Brazil.,Department of Medicine/Nephrology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Alvaro Pacheco-Silva
- Renal Transplantation Division, Hospital Israelita Albert Einstein, São Paulo, Brazil.,Department of Medicine/Nephrology, Universidade Federal de São Paulo, São Paulo, Brazil
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19
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Xue W, Tian P, Xiang H, Ding X, Pan X, Yan H, Hou J, Feng X, Liu L, Ding C, Tian X, Li Y, Zheng J. Outcomes for primary kidney transplantation from donation after Citizens' death in China: a single center experience of 367 cases. BMC Health Serv Res 2017; 17:250. [PMID: 28376778 PMCID: PMC5379606 DOI: 10.1186/s12913-017-2190-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 03/25/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The cases of donation after brain death followed by circulatory death (DBCD) and donation after cardiac death (DCD) have been increased year by year in China. Further research is needed to understand in the outcomes and risk factors of delayed graft function (DGF) in order to minimize the risk of DGF and ameliorate its potential impact on long-term outcomes. This study was to explore the differences in outcomes between DBCD and DCD transplant and the main risk factors for DGF in DBCD. METHODS Retrospective analysis of the clinical data of 367donations after citizens' death kidney transplant procedures (donors and recipients) between July 2012 and August 2015 at our center. RESULTS During the study period, the donation success rate was 25.3%. 164 cases of DBCD and 35 cases of DCD had been implemented and 367 kidneys were transplanted. The incidence of DGF in DBCD group were significantly lower than that of DCD group (12.0% vs. 27.0%, p = 0.002). The 1-year percent freedom from acute rejection (AR) was significantly higher in DBCD group compared with it of DCD group (94% vs. 82%, p = 0.036). Multivariate logistic regression analysis of the kidney transplants revealed that the high risk factors for DGF after renal transplantation in DBCD were history of hypertension (Odds Ratio [OR] = 5.88, 95% CI: 1.90 to 18.2, p = 0.002), low blood pressure (BP < 80 mmHg) (OR = 4.86, 95% CI: 1.58 to 14.9, p = 0.006) and serum creatinine of donor (OR = 1.09, 95% CI: 1.03 to 1.16, p = 0.003) before donation. CONCLUSIONS The outcomes of DBCD could be better than DCD in DGF and AR. The main risk factors for DGF in DBCD kidney transplants are donors with a history of hypertension, low blood pressure, and serum creatinine of donor before donation.
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Affiliation(s)
- Wujun Xue
- Department of Renal Transplant, Center of Nephropathy, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, 277 Yanta West Road, Xi’an, 710061 China
| | - Puxun Tian
- Department of Renal Transplant, Center of Nephropathy, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, 277 Yanta West Road, Xi’an, 710061 China
| | - Heli Xiang
- Department of Renal Transplant, Center of Nephropathy, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, 277 Yanta West Road, Xi’an, 710061 China
| | - Xiaoming Ding
- Department of Renal Transplant, Center of Nephropathy, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, 277 Yanta West Road, Xi’an, 710061 China
| | - Xiaoming Pan
- Department of Renal Transplant, Center of Nephropathy, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, 277 Yanta West Road, Xi’an, 710061 China
| | - Hang Yan
- Department of Renal Transplant, Center of Nephropathy, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, 277 Yanta West Road, Xi’an, 710061 China
| | - Jun Hou
- Department of Renal Transplant, Center of Nephropathy, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, 277 Yanta West Road, Xi’an, 710061 China
| | - Xinshun Feng
- Department of Renal Transplant, Center of Nephropathy, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, 277 Yanta West Road, Xi’an, 710061 China
| | - Linjuan Liu
- Department of Renal Transplant, Center of Nephropathy, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, 277 Yanta West Road, Xi’an, 710061 China
| | - Chenguang Ding
- Department of Renal Transplant, Center of Nephropathy, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, 277 Yanta West Road, Xi’an, 710061 China
| | - Xiaohui Tian
- Department of Renal Transplant, Center of Nephropathy, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, 277 Yanta West Road, Xi’an, 710061 China
| | - Yang Li
- Department of Renal Transplant, Center of Nephropathy, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, 277 Yanta West Road, Xi’an, 710061 China
| | - Jin Zheng
- Department of Renal Transplant, Center of Nephropathy, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, 277 Yanta West Road, Xi’an, 710061 China
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Diagnosing the Decades-Long Rise in the Deceased Donor Kidney Discard Rate in the United States. Transplantation 2017; 101:575-587. [DOI: 10.1097/tp.0000000000001539] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Nath J, Smith TB, Patel K, Ebbs SR, Hollis A, Tennant DA, Ludwig C, Ready AR. Metabolic differences between cold stored and machine perfused porcine kidneys: A 1 H NMR based study. Cryobiology 2017; 74:115-120. [DOI: 10.1016/j.cryobiol.2016.11.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 10/18/2016] [Accepted: 11/21/2016] [Indexed: 10/20/2022]
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Hameed AM, Pleass HC, Wong G, Hawthorne WJ. Maximizing kidneys for transplantation using machine perfusion: from the past to the future: A comprehensive systematic review and meta-analysis. Medicine (Baltimore) 2016; 95:e5083. [PMID: 27749583 PMCID: PMC5059086 DOI: 10.1097/md.0000000000005083] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 09/11/2016] [Accepted: 09/15/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The two main options for renal allograft preservation are static cold storage (CS) and machine perfusion (MP). There has been considerably increased interest in MP preservation of kidneys, however conflicting evidence regarding its efficacy and associated costs have impacted its scale of clinical uptake. Additionally, there is no clear consensus regarding oxygenation, and hypo- or normothermia, in conjunction with MP, and its mechanisms of action are also debated. The primary aims of this article were to elucidate the benefits of MP preservation with and without oxygenation, and/or under normothermic conditions, when compared with CS prior to deceased donor kidney transplantation. METHODS Clinical (observational studies and prospective trials) and animal (experimental) articles exploring the use of renal MP were assessed (EMBASE, Medline, and Cochrane databases). Meta-analyses were conducted for the comparisons between hypothermic MP (hypothermic machine perfusion [HMP]) and CS (human studies) and normothermic MP (warm (normothermic) perfusion [WP]) compared with CS or HMP (animal studies). The primary outcome was allograft function. Secondary outcomes included graft and patient survival, acute rejection and parameters of tubular, glomerular and endothelial function. Subgroup analyses were conducted in expanded criteria (ECD) and donation after circulatory (DCD) death donors. RESULTS A total of 101 studies (63 human and 38 animal) were included. There was a lower rate of delayed graft function in recipients with HMP donor grafts compared with CS kidneys (RR 0.77; 95% CI 0.69-0.87). Primary nonfunction (PNF) was reduced in ECD kidneys preserved by HMP (RR 0.28; 95% CI 0.09-0.89). Renal function in animal studies was significantly better in WP kidneys compared with both HMP (standardized mean difference [SMD] of peak creatinine 1.66; 95% CI 3.19 to 0.14) and CS (SMD of peak creatinine 1.72; 95% CI 3.09 to 0.34). MP improves renal preservation through the better maintenance of tubular, glomerular, and endothelial function and integrity. CONCLUSIONS HMP improves short-term outcomes after renal transplantation, with a less clear effect in the longer-term. There is considerable room for modification of the process to assess whether superior outcomes can be achieved through oxygenation, perfusion fluid manipulation, and alteration of perfusion temperature. In particular, correlative experimental (animal) data provides strong support for more clinical trials investigating normothermic MP.
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Affiliation(s)
- Ahmer M. Hameed
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research
- Department of Surgery, Westmead Hospital, Westmead
- Sydney Medical School, University of Sydney, Sydney
| | - Henry C. Pleass
- Department of Surgery, Westmead Hospital, Westmead
- Sydney Medical School, University of Sydney, Sydney
- Department of Surgery, Royal Prince Alfred Hospital, Camperdown
| | - Germaine Wong
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research
- Sydney School of Public Health, University of Sydney
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Wayne J. Hawthorne
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research
- Department of Surgery, Westmead Hospital, Westmead
- Sydney Medical School, University of Sydney, Sydney
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Paloyo S, Sageshima J, Gaynor JJ, Chen L, Ciancio G, Burke GW. Negative impact of prolonged cold storage time before machine perfusion preservation in donation after circulatory death kidney transplantation. Transpl Int 2016; 29:1117-25. [PMID: 27421771 DOI: 10.1111/tri.12818] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 02/23/2016] [Accepted: 07/13/2016] [Indexed: 01/26/2023]
Abstract
Kidney grafts are often preserved initially in static cold storage (CS) and subsequently on hypothermic machine perfusion (MP). However, the impact of CS/MP time on transplant outcome remains unclear. We evaluated the effect of prolonged CS/MP time in a single-center retrospective cohort of 59 donation after circulatory death (DCD) and 177 matched donation after brain death (DBD) kidney-alone transplant recipients. With mean overall CS/MP times of 6.0 h/30.0 h, overall incidence of delayed graft function (DGF) was higher in DCD transplants (30.5%) than DBD transplants (7.3%, P < 0.0001). In logistic regression, DCD recipient (P < 0.0001), longer CS time (P = 0.0002), male recipient (P = 0.02), and longer MP time (P = 0.08) were associated with higher DGF incidence. In evaluating the joint effects of donor type (DBD vs. DCD), CS time (<6 vs. ≥6 h), and MP time (<36 vs. ≥36 h) on DGF incidence, one clearly sees an unfavorable effect of MP time ≥36 h (P = 0.003) across each donor type and CS time stratum, whereas the unfavorable effect of CS time ≥6 h (P = 0.01) is primarily seen among DCD recipients. Prolonged cold ischemia time had no unfavorable effect on renal function or graft survival at 12mo post-transplant. Long CS/MP time detrimentally affects early DCD/DBD kidney transplant outcome when grafts were mainly preserved by MP; prolonged CS time before MP has a particularly negative impact in DCD kidney transplantation.
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Affiliation(s)
- Siegfredo Paloyo
- Department of Surgery, University of Miami Miller School of Medicine and Miami Transplant Institute, Miami, FL, USA
| | - Junichiro Sageshima
- Department of Surgery, University of Miami Miller School of Medicine and Miami Transplant Institute, Miami, FL, USA.
| | - Jeffrey J Gaynor
- Department of Surgery, University of Miami Miller School of Medicine and Miami Transplant Institute, Miami, FL, USA
| | - Linda Chen
- Department of Surgery, University of Miami Miller School of Medicine and Miami Transplant Institute, Miami, FL, USA
| | - Gaetano Ciancio
- Department of Surgery, University of Miami Miller School of Medicine and Miami Transplant Institute, Miami, FL, USA
| | - George W Burke
- Department of Surgery, University of Miami Miller School of Medicine and Miami Transplant Institute, Miami, FL, USA
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Center-level variation in the development of delayed graft function after deceased donor kidney transplantation. Transplantation 2015; 99:997-1002. [PMID: 25340600 DOI: 10.1097/tp.0000000000000450] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patient-level risk factors for delayed graft function (DGF) have been well described. However, the Organ Procurement and Transplantation Network definition of DGF is based on dialysis in the first week, which is subject to center-level practice patterns. It remains unclear if there are center-level differences in DGF and if measurable center characteristics can explain these differences. METHODS Using the 2003 to 2012 Scientific Registry of Transplant Recipients data, we developed a hierarchical (multilevel) model to determine the association between center characteristics and DGF incidence after adjusting for known patient risk factors and to quantify residual variability across centers after adjustment for these factors. RESULTS Of 82,143 deceased donor kidney transplant recipients, 27.0% developed DGF, with a range across centers of 3.2% to 63.3%. A center's proportion of preemptive transplants (odds ratio [OR], 0.83; per 5% increment; 95% confidence interval [95% CI], 0.74-;0.93; P = 0.001) and kidneys with longer than 30 hr of cold ischemia time (CIT) (OR, 0.95; per 5% increment; 95% CI, 0.92-;0.98; P = 0.001) were associated with less DGF. A center's proportion of donation after cardiac death donors (OR, 1.12; per 5% increment; 95% CI, 1.03-;1.17; P < 0.001) and imported kidneys (OR, 1.06; per 5% increment; 95% CI, 1.03-;1.10; P < 0.001) were associated with more DGF. After patient-level and center-level adjustments, only 41.8% of centers had DGF incidences consistent with the national median and 28.2% had incidences above the national median. CONCLUSION Significant heterogeneity in DGF incidences across centers, even after adjusting for patient-level and center-level characteristics, calls into question the generalizability and validity of the current DGF definition. Enhanced understanding of center-level variability and improving the definition of DGF accordingly may improve DGF's utility in clinical care and as a surrogate endpoint in clinical trials.
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Metabolomic analysis of perfusate during hypothermic machine perfusion of human cadaveric kidneys. Transplantation 2015; 99:754-9. [PMID: 25222017 DOI: 10.1097/tp.0000000000000398] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The metabolic processes occurring within the preserved kidney during hypothermic machine perfusion (HMP) are not well characterized. The aim of this study was to use nuclear magnetic resonance (NMR) spectroscopy to examine the metabolomic profile of HMP perfusate from human cadaveric kidneys awaiting transplantation and to identify possible discriminators between the profiles of kidneys with delayed graft function (DGF) and immediate graft function (IGF). METHODS Perfusates from HMP kidneys were sampled at 45 min and 4 hr of preservation with the LifePort Kidney Transporter 1.0 (Organ Recovery Systems, Chicago, IL) using KPS-1. Prepared samples underwent 1-D Proton-NMR spectroscopy, and resultant spectra were analyzed. Clinical parameters were collected prospectively. RESULTS Perfusate of 26 transplanted cadaveric kidneys was analyzed; 19(73%) with IGF and 7(27%) with DGF. Glucose concentrations were significantly lower in DGF kidneys compared to those with IGF at both 45 min (7.772 vs. 9.459 mM, P = 0.006) and 4 hr (8.202 vs. 10.235 mM, P = 0.003). Concentrations of inosine and leucine were significantly different between DGF and IGF kidneys at 45 min (0.002 vs. 0.013 mM, P = 0.009 and 0.011 vs. 0.006 mM, P = 0.036), and gluconate levels were also significantly different between DGF and IGF kidneys at 4 hr (49.099 vs. 59.513 mM, P = 0.009). CONCLUSION Significant metabolic activity may be occurring in kidneys during HMP. The NMR spectroscopy of the perfusate can identify differences in the metabolomic profiles of DGF and IGF kidneys that might have a predictive role in viability assessment. Modification of harmful metabolic processes may improve outcomes for HMP kidneys.
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Should Pulsatile Preservation Be the Gold Standard in Kidney Transplantation? CURRENT TRANSPLANTATION REPORTS 2015. [DOI: 10.1007/s40472-015-0063-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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. EXP CLIN TRANSPLANT 2015; 13. [DOI: 10.6002/ect.2014.0174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Nath J, Guy A, Smith TB, Cobbold M, Inston NG, Hodson J, Tennant DA, Ludwig C, Ready AR. Metabolomic perfusate analysis during kidney machine perfusion: the pig provides an appropriate model for human studies. PLoS One 2014; 9:e114818. [PMID: 25502759 PMCID: PMC4264773 DOI: 10.1371/journal.pone.0114818] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 10/21/2014] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Hypothermic machine perfusion offers great promise in kidney transplantation and experimental studies are needed to establish the optimal conditions for this to occur. Pig kidneys are considered to be a good model for this purpose and share many properties with human organs. However it is not established whether the metabolism of pig kidneys in such hypothermic hypoxic conditions is comparable to human organs. METHODS Standard criteria human (n = 12) and porcine (n = 10) kidneys underwent HMP using the LifePort Kidney Transporter 1.0 (Organ Recovery Systems) using KPS-1 solution. Perfusate was sampled at 45 minutes and 4 hours of perfusion and metabolomic analysis performed using 1-D 1H-NMR spectroscopy. RESULTS There was no inter-species difference in the number of metabolites identified. Of the 30 metabolites analysed, 16 (53.3%) were present in comparable concentrations in the pig and human kidney perfusates. The rate of change of concentration for 3-Hydroxybutyrate was greater for human kidneys (p<0.001). For the other 29 metabolites (96.7%), there was no difference in the rate of change of concentration between pig and human samples. CONCLUSIONS Whilst there are some differences between pig and human kidneys during HMP they appear to be metabolically similar and the pig seems to be a valid model for human studies.
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Affiliation(s)
- Jay Nath
- Department of Renal Surgery, University Hospitals Birmingham, Birmingham, United Kingdom
- Department of Immunity & Infection, University of Birmingham, Birmingham, United Kingdom
- School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom
- * E-mail:
| | - Alison Guy
- Department of Renal Surgery, University Hospitals Birmingham, Birmingham, United Kingdom
- Department of Immunity & Infection, University of Birmingham, Birmingham, United Kingdom
| | - Thomas B. Smith
- Department of Immunity & Infection, University of Birmingham, Birmingham, United Kingdom
| | - Mark Cobbold
- Department of Immunity & Infection, University of Birmingham, Birmingham, United Kingdom
| | - Nicholas G. Inston
- Department of Renal Surgery, University Hospitals Birmingham, Birmingham, United Kingdom
| | - James Hodson
- Wolfson Computer Laboratory, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Daniel A. Tennant
- School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Christian Ludwig
- Henry Wellcome Building for Biomolecular NMR Spectroscopy, University of Birmingham, Birmingham, United Kingdom
| | - Andrew R. Ready
- Department of Renal Surgery, University Hospitals Birmingham, Birmingham, United Kingdom
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Abstract
PURPOSE OF REVIEW Acute kidney injury (AKI) in transplant recipients is a prevalent condition with a broad list of potential inciting causes. This review highlights recent data describing the epidemiology and long-term consequences of transplant AKI, novel interventions in the management of delayed graft function (DGF), and noninvasive diagnostic strategies. RECENT FINDINGS The incidence and outcomes of nontransplant AKI are well documented, and similar data are emerging in the transplant setting with recent reports suggesting a high incidence rate and significant impact on long-term graft outcomes. DGF represents a 'pure' form of transplant AKI, and many interventional trials aiming to limit ischemia-reperfusion-induced injury have recently been reported or are currently ongoing. The search for accurate noninvasive predictors of DGF and acute rejection is ongoing and recent literature describes novel plasma and urine-based biomarkers as well as transcriptional profiling methods with high potential for clinical applicability. SUMMARY AKI in transplant recipients is a frequent occurrence with significant potential for poor long-term graft outcomes. Recent efforts to limit ischemia-reperfusion injury and diagnose transplant AKI via noninvasive methods may help to minimize the impact of AKI on future graft function.
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Pulsatile Perfusion Reduces the Risk of Delayed Graft Function in Deceased Donor Kidney Transplants, Irrespective of Donor Type and Cold Ischemic Time. Transplantation 2014; 97:668-74. [DOI: 10.1097/01.tp.0000438637.29214.10] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Hall IE, Reese PP, Weng FL, Schröppel B, Doshi MD, Hasz RD, Reitsma W, Goldstein MJ, Hong K, Parikh CR. Preimplant histologic acute tubular necrosis and allograft outcomes. Clin J Am Soc Nephrol 2014; 9:573-82. [PMID: 24558049 PMCID: PMC3944773 DOI: 10.2215/cjn.08270813] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 12/04/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES The influence of deceased-donor AKI on post-transplant outcomes is poorly understood. The few published studies about deceased-donor preimplant biopsy have reported conflicting results regarding associations between AKI and recipient outcomes. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This multicenter study aimed to evaluate associations between deceased-donor biopsy reports of acute tubular necrosis (ATN) and delayed graft function (DGF), and secondarily for death-censored graft failure, first adjusting for the kidney donor risk index and then stratifying by donation after cardiac death (DCD) status. RESULTS Between March 2010 and April 2012, 651 kidneys (369 donors, 4 organ procurement organizations) were biopsied and subsequently transplanted, with ATN reported in 110 (17%). There were 262 recipients (40%) who experienced DGF and 38 (6%) who experienced graft failure. DGF occurred in 45% of kidneys with reported ATN compared with 39% without ATN (P=0.31) resulting in a relative risk (RR) of 1.13 (95% confidence interval [95% CI], 0.9 to 1.43) and a kidney donor risk index-adjusted RR of 1.11 (95% CI, 0.88 to 1.41). There was no significant difference in graft failure for kidneys with versus without ATN (8% versus 5%). In stratified analyses, the adjusted RR for DGF with ATN was 0.97 (95% CI, 0.7 to 1.34) for non-DCD kidneys and 1.59 (95% CI, 1.23 to 2.06) for DCD kidneys (P=0.02 for the interaction between ATN and DCD on the development of DGF). CONCLUSIONS Despite a modest association with DGF for DCD kidneys, this study reveals no significant associations overall between preimplant biopsy-reported ATN and the outcomes of DGF or graft failure. The potential benefit of more rigorous ATN reporting is unclear, but these findings provide little evidence to suggest that current ATN reports are useful for predicting graft outcomes or deciding to accept or reject allograft offers.
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Affiliation(s)
- Isaac E. Hall
- Program of Applied Translational Research, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
- Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut
| | | | | | | | | | - Rick D. Hasz
- Gift of Life Institute, Philadelphia, Pennsylvania
| | | | - Michael J. Goldstein
- Mount Sinai School of Medicine and New York Organ Donor Network, New York, New York; and
| | - Kwangik Hong
- Program of Applied Translational Research, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Chirag R. Parikh
- Program of Applied Translational Research, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
- Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut
- Section of Nephrology, Veterans Affairs Medical Center, West Haven, Connecticut
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Antoine C, Mourey F, Prada-Bordenave E. How France launched its donation after cardiac death program. ACTA ACUST UNITED AC 2014; 33:138-43. [DOI: 10.1016/j.annfar.2013.11.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Elec FI, Lucan C, Ghervan L, Munteanu V, Moga S, Suciu M, Enache D, Elec A, Munteanu A, Barbos A, Iacob G, Lucan M. Ex-vivo perfusion machines in kidney transplantation. The significance of the resistivity index. CLUJUL MEDICAL 2014; 87:27-9. [PMID: 26527992 PMCID: PMC4462411 DOI: 10.15386/cjm.2014.8872.871.fie1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 02/10/2014] [Indexed: 11/23/2022]
Abstract
Introduction With a growing shortage of organs for transplantation, finding ways of increasing the donor organ pool remains of utmost importance. Perfusion machines (PM) have been proven to enhance the potential for kidney transplants to function sooner, last longer, giving patients the opportunity for a better life quality. Objective The aim of this study is to evaluate the relation between the resistance index provided by the PM, the postoperative resistance index measured by Doppler ultrasound and the initial graft outcome. Material and method Between January 2012-December 2012, clinical data obtained from 82 consecutive renal transplants from brain death donors (BDD) which underwent PM maintenance were analyzed in a transversal study. Prior transplantation we recorded the solution temperature, filtration rate and the resistance index provided by PM. After the surgical intervention, each patient had standard follow-up. Doppler ultrasound resistivity index (RI) was recorded on the first postoperative day. Results Out of 115 renal transplants, 98 (85.21%) were performed with grafts from BDD. The PM was used for 82 renal grafts. The Doppler resistance index in relation to the resistance index shows a highly statistical correlation by linear regression (R=0.813, p<0.0001). Primary graft function was recorded in 74 patients (90.24%) and it was highly statistically significant correlated with the resistance index measured by PM. Out of 8 patients with primary non-function, 6 patients recovered with normal graft function at one year. Conclusion The resistivity index recorded by the life-port machine is correlated with the vascular resistivity index measured by Doppler ultrasound and thus it may predicts the primary graft outcome.
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Affiliation(s)
- Florin Ioan Elec
- Clinical Institute of Urology and Renal Transplantation Cluj-Napoca
| | - Ciprian Lucan
- Clinical Institute of Urology and Renal Transplantation Cluj-Napoca
| | - Liviu Ghervan
- Clinical Institute of Urology and Renal Transplantation Cluj-Napoca
| | | | - Silviu Moga
- Clinical Institute of Urology and Renal Transplantation Cluj-Napoca
| | - Mihai Suciu
- Clinical Institute of Urology and Renal Transplantation Cluj-Napoca
| | - Dan Enache
- Clinical Institute of Urology and Renal Transplantation Cluj-Napoca
| | - Alina Elec
- Clinical Institute of Urology and Renal Transplantation Cluj-Napoca
| | - Adriana Munteanu
- Clinical Institute of Urology and Renal Transplantation Cluj-Napoca
| | - Adrian Barbos
- Clinical Institute of Urology and Renal Transplantation Cluj-Napoca
| | - Gheorghita Iacob
- Clinical Institute of Urology and Renal Transplantation Cluj-Napoca
| | - Mihai Lucan
- Clinical Institute of Urology and Renal Transplantation Cluj-Napoca
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O'Callaghan JM, Morgan RD, Knight SR, Morris PJ. Systematic review and meta-analysis of hypothermic machine perfusion versus static cold storage of kidney allografts on transplant outcomes. Br J Surg 2013; 100:991-1001. [PMID: 23754643 DOI: 10.1002/bjs.9169] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 05/08/2012] [Accepted: 04/11/2013] [Indexed: 02/05/2023]
Abstract
BACKGROUND Adequate preservation of renal allografts for transplantation is important for maintaining and improving transplant outcomes. There are two prevalent methods: hypothermic machine perfusion and static cold storage. The preferred method of storage, however, remains controversial. The objective was to review systematically the evidence comparing outcomes from these two modalities. METHODS A literature search was performed using MEDLINE, Embase, the Cochrane Library, the Transplant Library and the International Clinical Trials Registry Platform. The final date for searches was 30 November 2012. Studies were assessed for methodological quality. Summary effects were calculated as relative risk (RR) with 95 per cent confidence interval (c.i.). Randomized clinical trials (RCTs) and non-RCTs were included, but evaluated separately. Results from RCTs alone were used for meta-analysis. RESULTS Eighteen studies met the inclusion criteria, including seven RCTs (1475 kidneys) and 11 non-RCTs (728 kidneys). The overall risk of delayed graft function was lower with hypothermic machine perfusion than static cold storage (RR 0·81, 95 per cent c.i. 0·71 to 0·92; P = 0·002). There was no difference in the rate of primary non-function (RR 1·15, 0·46 to 2·90; P = 0·767). There was a faster initial fall in the level of serum creatinine with hypothermic machine perfusion in two RCTs, but not in another. There was no relationship between rates of acute rejection or patient survival and the method of preservation. CONCLUSION Data from the included studies suggest that hypothermic machine perfusion reduces delayed graft function compared with static cold storage. There was no difference in primary non-function, acute rejection, long-term renal function or patient survival. A difference in renal graft survival is uncertain.
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Affiliation(s)
- J M O'Callaghan
- Centre for Evidence in Transplantation, Royal College of Surgeons of England and London School of Hygiene and Tropical Medicine, University of London, London, UK.
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Sharif A, Borrows R. Who, how and when to pump: teasing out the devil in the details. Am J Transplant 2013; 13:821-2. [PMID: 23331551 DOI: 10.1111/ajt.12059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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