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Updated: Jun 16, 2026
Normothermic Ex Vivo Kidney Perfusion for the Preservation of Kidney Grafts prior to Transplantation
Published on: July 15, 2015
Machine perfusion preservation for kidney grafts with a high creatinine from uncontrolled donation after cardiac
N Matsuno1, Y N O Konno, Y Jyojima
1The 5th Department of Surgery, Hachioji Medical Center of Tokyo Medical University, Tokyo, Japan. mtn@tokyo-med.ac.jp
Insights
Machine perfusion parameters reliably assess kidney viability from donation after cardiac arrest (DCA) donors with high creatinine. Older donors (>50 years) can be acceptable, though they may experience delayed graft function.
Area of Science:
- Nephrology
- Transplantation
- Organ Preservation
Background:
- Donation after cardiac arrest (DCA) donors with high creatinine levels present a challenge for kidney transplantation.
- Evaluating the suitability of older DCA donors (>50 years) with elevated creatinine is crucial for expanding the donor pool.
Purpose of the Study:
- To assess the utility of machine perfusion parameters in selecting kidneys from DCA donors with high creatinine levels.
- To determine the acceptability of kidneys from DCA donors over 50 years old with elevated creatinine.
Main Methods:
- Seventeen kidneys from uncontrolled DCA donors with pre-procurement creatinine >3.0 mg/dL were analyzed.
- Donors were categorized into two groups: <50 years (Group 1, n=9) and >50 years (Group 2, n=8).
- Machine perfusion parameters including resistance and flow rate were compared between groups.
Main Results:
- No significant differences in donor characteristics or preservation times were observed between the groups.
- Group 2 (older donors) exhibited higher perfusion resistance (47.9 mmHg/mL/min/g) compared to Group 1 (42.5 mmHg/mL/min/g).
- Acute tubular necrosis (ATN) recovery was longer in Group 2 (21.2 days) versus Group 1 (8.2 days), with similar flow rates and improved creatinine levels in Group 1.
Conclusions:
- Machine perfusion flow is a dependable indicator of graft viability in DCA kidneys, especially those with high creatinine.
- Older DCA donors (>50 years) can be considered for transplantation if machine perfusion parameters are favorable, but careful monitoring for delayed graft function is necessary.
Background:
This study evaluated the usefulness of machine perfusion preservation parameters as selection criteria for donation after cardiac arrest (DCD) with high creatinine level. The aim of this study is to evaluate to whether DCD donor >50 years old and with high creatinine are acceptable.
Methods:
We examined 17 kidneys from uncontrolled DCD who showed creatinine levels >3.0 mg/dL before procurement. The study included the following two groups: group 1 (n = 9), donor age <50 years old versus group 2 (n = 8), donor age >50 years old.
Results:
There were no significant differences in donors or preservation conditions among the 2 groups, including age, terminal creatinine, warm ischemic time, cold perfusion time, and total ischemic time. A greater resistance of 47.9 mmHg/mL per min/g was observed among group 2, compared with 42.5 mmHg/mL per min/g in group 1. A shorter ATN period (8.2 days) was noted in group 1, compared with 21.2 days for group 2. The flow rate (mL/g/min) was not significantly different between the two groups. The best-Cr level was 1.22 mg/dL in group 1 and 1.94 mg/dL in group 2.
Conclusion:
Machine perfusion flow was a reliable indicator of graft viability in uncontrolled DCD, particularly kidneys with high creatinine level. Even older donors were acceptable if the machine perfusion preservation parameters such as flow rate and pressure were acceptable; however, they may show severe delayed graft function.
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