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Extracorporeal support: improves donor renal graft function after cardiac death

A Rojas-Pena1, J L Reoma, E Krause

  • 1General Surgery Department, Division of Transplantation, University of Michigan Health System, Ann Arbor, MI, USA. alvaror@umich.edu

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons
|June 18, 2010
PubMed

Insights

Extracorporeal support after cardiac death (ECS-DCD) can improve kidney function after cardiac arrest. This technique may help more organs from donors after cardiac death (DCD) become viable for transplantation.

Area of Science:

  • Transplantation immunology
  • Organ preservation
  • Nephrology

Background:

  • Donors after cardiac death (DCD) offer a potential solution to expand the deceased donor organ pool.
  • However, delayed graft function and primary nonfunction in DCD kidneys limit their utilization.
  • Extracorporeal support after cardiac death (ECS-DCD) has emerged as a strategy to mitigate these complications.

Purpose of the Study:

  • To evaluate the immediate and acute renal function of kidneys from different donor types.
  • To compare the efficacy of conventional rapid recovery versus ECS in DCD kidney recovery.
  • To assess the impact of varying warm ischemia times on DCD kidney function post-transplantation.

Main Methods:

  • Kidneys from DCD donors (recovered conventionally or with ECS) and living donors (LVD) were transplanted into nephrectomized swine.
  • Warm ischemia times of 10 and 30 minutes were investigated for DCD kidneys.
  • ECS-DCD kidneys underwent 90 minutes of perfusion prior to cold storage (4-6 hours) and transplantation.
  • Post-transplant assessments included renal vascular resistance (RVR), urine output (UO), urine protein concentration (UrPr), and creatinine clearance (CrCl) over 4 hours.

Main Results:

  • All transplanted kidney grafts demonstrated adequate renal blood flow during the 4-hour assessment period.
  • Renal vascular resistance (RVR) returned to baseline levels only in the LVD group, remaining elevated in all DCD groups.
  • While urine output exceeded 50 mL/h in most DCD groups, the DCD group with 30 minutes of warm ischemia (DCD-30) exhibited significantly reduced urine output (6.8 mL/h).
  • The DCD-30 group also showed lower creatinine clearance (0.9 mL/min) and higher urine protein concentration (>200 mg/dL) compared to other DCD groups.

Conclusions:

  • Normothermic extracorporeal support (ECS) can effectively resuscitate kidneys, rendering them transplantable even after 30 minutes of cardiac arrest and warm ischemia.
  • ECS-DCD shows promise in improving the viability and function of DCD kidneys, potentially increasing their utilization in transplantation.
  • The duration of warm ischemia remains a critical factor influencing post-transplant renal function in DCD kidneys, even with ECS intervention.

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