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Recent Methods of Kidney Storage and Therapeutic Possibilities of Transplant Kidney
Anna Radajewska1, Anna Krzywonos-Zawadzka1, Iwona Bil-Lula1
1Department of Medical Laboratory Diagnostics, Division of Clinical Chemistry and Laboratory Hematology, Faculty of Pharmacy, Wroclaw Medical University, Borowska 211A, 50-556 Wroclaw, Poland.
Abstract:
Kidney transplantation is the standard procedure for the treatment of end-stage renal disease (ESRD). During kidney storage and before implantation, the organ is exposed to damaging factors which affect the decline in condition. The arrest of blood circulation results in oxygen and nutrient deficiency that lead to changes in the cell metabolism from aerobic to anaerobic, damaging organelles and cell structures. Currently, most kidney grafts are kept in a cold preservation solution to preserve low metabolism. However, there are numerous reports that machine perfusion is a better solution for organ preservation before surgery. The superiority of machine perfusion was proved in the case of marginal donor grafts, such as extended criteria donors (ECD) and donation after circulatory death (DCD). Different variant of kidney machine perfusions are evaluated. Investigators look for optimal conditions to protect kidneys from ischemia-reperfusion damage consequences by examining the best temperature conditions and comparing systems with constant or pulsatile flow. Moreover, machine perfusion brings additional advantages in clinical practice. Unlike cold static storage, machine perfusion allows the monitoring of the parameters of organ function, which gives a real possibility to make a decision prior to transplantation concerning whether the kidney is suitable for implantation. Moreover, new pharmacological therapies are sought to minimize organ damage. New components or cellular therapies can be applied, since perfusion solution flows through the organ. This review outlines the pros and cons of each machine perfusion technique and summarizes the latest achievements in the context of kidney transplantation using machine perfusion systems.
Insights
Machine perfusion offers superior kidney preservation compared to cold storage, especially for marginal donor organs. This technique allows real-time monitoring, aiding pre-transplant suitability decisions and enabling new therapies.
Area of Science:
- Nephrology
- Transplantation immunology
- Organ preservation technologies
Background:
- End-stage renal disease (ESRD) necessitates kidney transplantation.
- Organ damage occurs during cold storage due to ischemia and nutrient deficiency.
- Current cold static storage methods have limitations in preserving graft quality.
Purpose of the Study:
- To review and compare machine perfusion techniques for kidney graft preservation.
- To evaluate the benefits of machine perfusion over traditional cold storage.
- To summarize advancements in optimizing machine perfusion for kidney transplantation.
Main Methods:
- Review of existing literature on kidney machine perfusion systems.
- Comparison of different machine perfusion variants (e.g., temperature, flow patterns).
- Analysis of clinical data regarding graft outcomes with machine perfusion.
Main Results:
- Machine perfusion demonstrates superiority, particularly for marginal donor kidneys (ECD, DCD).
- Allows continuous monitoring of organ function, aiding pre-transplant assessment.
- Facilitates the application of novel pharmacological and cellular therapies during preservation.
Conclusions:
- Machine perfusion represents an advancement in kidney preservation for transplantation.
- It offers improved outcomes and decision-making capabilities compared to cold static storage.
- Ongoing research focuses on optimizing perfusion parameters and adjunct therapies.