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Normothermic Ex Vivo Kidney Perfusion for the Preservation of Kidney Grafts prior to Transplantation
Published on: July 15, 2015
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Ex-vivo Kidney Machine Perfusion: Therapeutic Potential
Ruta Zulpaite1,2, Povilas Miknevicius1,2, Bettina Leber1
1General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.
Frontiers in Medicine
|January 10, 2022
Summary
Ex-vivo machine perfusion enhances kidney preservation and quality for transplantation. This technique allows for targeted therapies to minimize injury and reduce immune rejection, improving outcomes for kidney transplant recipients.
Area of Science:
- Transplantation immunology
- Organ preservation
- Nephrology
Background:
- Kidney transplantation is the optimal treatment for end-stage kidney disease.
- Increasing demand necessitates using grafts from donors after circulatory death (DCD) or extended criteria donors (ECD).
- These grafts are vulnerable to ischemia-reperfusion injury, immunogenicity, and complex immune regulation.
Purpose of the Study:
- To review the current evidence on ex-vivo kidney machine perfusion.
- To explore its potential for kidney graft treatment and quality improvement.
- To discuss challenges in applying these novel techniques clinically.
Main Methods:
- Review of existing literature on ex-vivo kidney machine perfusion.
- Analysis of studies investigating perfusion variables (temperature, oxygen, perfusate).
- Examination of experimental models delivering therapies during perfusion (pharmacological agents, gene therapy, stem cells, nanoparticles).
Main Results:
- Hypothermic machine perfusion has proven superior to static cold storage in reducing delayed graft function.
- Ex-vivo machine perfusion offers a platform for organ conditioning and targeted treatment.
- Experimental models show successful delivery of various therapies ex-vivo to minimize injury and immunogenicity.
Conclusions:
- Ex-vivo machine perfusion is evolving beyond preservation to active organ treatment.
- It holds significant potential for minimizing ischemia-reperfusion injury and reducing immunogenicity, potentially leading to tolerance.
- Clinical application faces challenges that require further investigation and development.
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