Corrigendum: Ex vivo normothermic preservation of a kidney graft from uncontrolled donation after circulatory death over 73 hours

[This corrects the article DOI: 10.3389/fbioe.2023.1330043.].

Ex vivo normothermic preservation of a kidney graft from uncontrolled donation after circulatory death over 73 hours

The transplant community is focused on prolonging the ex vivo preservation time of kidney grafts to allow for long-distance kidney graft transportation, assess the viability of marginal grafts, and optimize a platform for the translation of innovative therapeutics to clinical practice, especially those focused on cell and vector delivery to organ conditioning and reprogramming. We describe the first case of feasible preservation of a kidney from a donor after uncontrolled circulatory death over a 73-h period using normothermic perfusion and analyze hemodynamic, biochemical, histological, and transcriptomic parameters for inflammation and kidney injury. The mean pressure and flow values were 71.24 ± 9.62 mmHg and 99.65 ± 18.54 mL/min, respectively. The temperature range was 36.7°C-37.2°C. The renal resistance index was 0.75 ± 0.15 mmHg/mL/min. The mean pH was 7.29 ± 0.15. The lactate concentration peak increased until 213 mg/dL at 6 h, reaching normal values after 34 h of perfusion (8.92 mg/dL). The total urine output at the end of perfusion was 1.185 mL. Histological analysis revealed no significant increase in acute tubular necrosis (ATN) severity as perfusion progressed. The expression of KIM-1, VEGF, and TGFβ decreased after 6-18 h of perfusion until 60 h in which the expression of these genes increased again together with the expression of β-catenin, Ki67, and TIMP1. We show that normothermic perfusion can maintain a kidney graft viable ex vivo for 3 days, thus allowing a rapid translation of pre-clinical therapeutics to clinical practice.

Effect of Active and Early Possible Organ and Tissue Donor Detection in the Emergency Room in a University Hospital

PURPOSE

The emergency room of the hospital is the gateway for patients with severe brain damage due to neurologic or cardiac conditions such as stroke or cardiac arrest. The main purpose is to design an active registry of patients, in the emergency room, to facilitate the detection and follow-up of potential donors according to their clinical evolution.

MATERIAL AND METHODS

This is a 1-year prospective study from May 2017 to May 2018 with a register for detection of patients admitted to the emergency room with severe brain damage (Glasgow Coma Scale score ≤ 8), with active follow-up until hospital discharge, who might have died or otherwise become possible organ and tissue donors.

RESULTS

One hundred sixty-six (107 men and 59 women) patients met the inclusion criteria: (1) 30.7% recovered from cardiac arrest; (2) 31.3% from stroke; (3) 16.9% from traumatic brain injury and multiple trauma; (4) 10.2% had decreased level of consciousness; (5) 4.8% had other cardiac conditions; and (6) 6.0% had other diagnoses. Seventy-seven out of 166 patients (46.4%) were evaluated as possible organ and tissue donors, with 37 out of 77 (48.0%) of the possible donors becoming real donors. This means that 37 out of 166 (22.3%) of the possible donors admitted to the emergency room became real donors. Twenty-two out of 77 of the patients (28.6%) evaluated had clinical contraindications for donation and in 18 out of 77 (23.4%), there was family refusal for any kind of organ or tissue donation. This record allowed the generation of the following organs and tissues: 4 hearts, 19 livers, 14 lungs, 52 kidneys, 2 pancreata, 29 corneas, 19 donations of bone allografts, 15 donations of skin tissue, 14 donations of valvular allografts, and 11 vascular allografts.

CONCLUSIONS

The early and active possible donors registry at the emergency room has facilitated early detection and allow adequate follow-up and evaluation of possible organ and tissue donors.