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Updated: Jun 1, 2026
Normothermic Ex Vivo Kidney Perfusion for the Preservation of Kidney Grafts prior to Transplantation
Published on: July 15, 2015
Preservation of kidneys from controlled donors after cardiac death
J Wind1, M G J Snoeijs, J A van der Vliet
1Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands. t.wind@mumc.nl
Insights
Direct aortic cannulation is a superior method for preserving kidneys from controlled donation after cardiac death (DCD) donors, reducing discard rates and improving graft survival compared to the double-balloon triple-lumen catheter technique.
Area of Science:
- Nephrology
- Transplantation Surgery
- Organ Preservation
Background:
- Donation after cardiac death (DCD) increases kidney donor pool but risks warm ischaemic injury.
- Current preservation methods include in situ double-balloon triple-lumen catheter (DBTL) and direct aortic cannulation.
- Comparing these techniques is crucial for optimizing DCD kidney utilization.
Purpose of the Study:
- To compare the efficacy of DBTL catheter preservation versus direct aortic cannulation for controlled DCD kidneys.
- To evaluate the impact of preservation method on kidney discard rates and ischaemia times.
- To assess the long-term graft survival outcomes associated with each preservation technique.
Main Methods:
- Retrospective cohort study of 165 controlled DCD procedures.
- Data collected from two regions in the Netherlands between 2000 and 2006.
- Comparison of kidney discard rates, warm and cold ischaemia times, and graft survival between DBTL and aortic cannulation groups.
Main Results:
- The aortic cannulation group had significantly lower kidney discard rates (4.8% vs 28.2%) and shorter warm (22 vs 27 min) and cold (19 vs 24 h) ischaemia times.
- DBTL catheter preservation (OR 5.19) and increased donor age were risk factors for kidney discard.
- Shorter warm ischaemia time significantly reduced graft failure risk, leading to higher 1-year graft survival in the aortic group (86.2% vs 76.8%).
Conclusions:
- Direct aortic cannulation is a more effective method for preserving controlled DCD kidneys.
- This technique leads to reduced discard rates and improved long-term graft survival.
- Optimizing preservation strategies is key to maximizing the benefit of DCD kidney transplantation.
Background:
Donation after cardiac death (DCD) expands the pool of donor kidneys, but is associated with warm ischaemic injury. Two methods are used to preserve kidneys from controlled DCD donors and reduce warm ischaemic injury: in situ preservation using a double-balloon triple-lumen catheter (DBTL) inserted via the femoral artery and direct cannulation of the aorta after rapid laparotomy. The aim of this study was to compare these two techniques.
Methods:
This was a retrospective cohort study of 165 controlled DCD procedures in two regions in the Netherlands between 2000 and 2006.
Results:
There were 102 donors in the DBTL group and 63 in the aortic group. In the aortic group the kidney discard rate was lower (4·8 versus 28·2 per cent; P < 0·001), and the warm (22 versus 27 min; P < 0·001) and the cold (19 versus 24 h; P < 0·001) ischaemia times were shorter than in the DBTL group. Risk factors for discard included preservation with the DBTL catheter (odds ratio (OR) 5·19, 95 per cent confidence interval 1·88 to 14·36; P = 0·001) and increasing donor age (1·05, 1·02 to 1·07; P < 0·001). Warm ischaemia time had a significant effect on graft failure (hazard ratio 1·04, 1·01 to 1·07; P = 0·009), and consequently graft survival was higher in the aortic cannulation group (86·2 per cent versus 76·8 per cent in the DBTL group at 1 year; P = 0·027).
Conclusion:
In this retrospective study, direct aortic cannulation appeared to be a better method to preserve controlled DCD kidneys.
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