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Machine perfusion for kidneys: how to do it at minimal cost.
S Balupuri1, A Strong, N Hoernich
1Renal and Liver Transplant Unit, Level 5, Freeman Hospital, High Heaton, Newcastle upon Tyne, NE7 7DN, UK.
Summary
Researchers developed an affordable hypothermic pulsatile perfusion system using dialysis equipment to assess the viability of marginal kidney grafts from non-heart-beating donors (NHBD), improving organ transplantation outcomes.
Area of Science:
- Nephrology
- Transplantation immunology
- Biomedical engineering
Background:
- Organ transplantation faces a shortage, leading to the use of marginal grafts.
- Kidneys from non-heart-beating donors (NHBD) often have initial ischemic damage, making viability assessment challenging.
- Hypothermic pulsatile perfusion can improve and assess the viability of marginal grafts but requires expensive systems.
Purpose of the Study:
- To develop a cost-effective hypothermic pulsatile perfusion system for assessing NHBD kidney viability.
- To evaluate the efficacy of the developed system in predicting graft viability.
Main Methods:
- Utilized existing dialysis equipment with modified inserts to create a pulsatile hypothermic perfusion system.
- Perfused 41 NHBD kidneys for up to 8 hours.
- Assessed graft viability using intravascular renal resistance (IRVR), flow characteristics, and glutathione S transferase (GST) measurements.
Main Results:
- The developed system successfully perfused NHBD kidneys.
- Viability assessment parameters (IRVR, flow, GST) were measured.
- The system proved effective in evaluating marginal kidney grafts.
Conclusions:
- A cost-effective hypothermic pulsatile perfusion system was successfully developed using readily available dialysis equipment.
- This system is a valuable tool for assessing the viability of NHBD kidneys.
- The developed system is now integral to the NHBD kidney transplantation program.