Pulsatile machine perfusion with Vasosol solution improves early graft function after cadaveric renal transplantation.
BACKGROUND
Cold storage is the most common method of preservation in renal transplantation, but pulsatile machine perfusion (MP) is increasingly used for purposes of ex vivo assessment and resuscitation of high risk allografts. Vasosol (VSL) MP solution (MPS) (Pike Laboratories Inc, Eagle, PA) is a novel perfusate with enhanced vasodilatory and antioxidant capacity. We report our experience with VSL in machine preservation of renal allografts.


METHODS
Locally procured cadaver kidney pairs undergoing MP were randomized to VSL or control solution (Belzer MPS; Trans-Med, Elk River, MN). En bloc perfusion was performed according to standard MP procedures. Transplantation was performed at 1 of 12 local transplant centers. Donor and recipient data were collected prospectively.


RESULTS
Data from 162 transplanted kidneys were analyzed. A total of 82 renal grafts were perfused with VSL, and 80 were perfused with control solution. No organs were lost secondary to the technique of MP. There was no difference in donor or recipient age between groups. Kidneys perfused with VSL exhibited significantly higher rates of immediate function and significantly less delayed graft function (12.2% vs. 21.2%). Discharge creatinine and length of stay were also significantly improved in the VSL group. One-year graft and patient survivals were equivalent (95%) in both groups.


CONCLUSIONS
VSL improved early graft function and shortened the length of stay compared with Belzer MPS. Further improvement in preservation solutions in conjunction with pulsatile perfusion shows promise in improving early outcomes after renal transplantation, especially for extended criteria donor kidneys.
Guarrera
James V
JV
New York Presbyterian Hospital Organ Preservation Unit, New York, New York 10021, USA. jjg46@columbia.edu
Polyak
Maximilian
M
O'Mar Arrington
Ben
B
Kapur
Sandip
S
Stubenbord
William T
WT
Kinkhabwala
Milan
M
D000241:Adenosine; D000328:Adult; D000368:Aged; D000493:Allopurinol; D002102:Cadaver; D005978:Glutathione; D006085:Graft Survival; D006801:Humans; D066298:In Vitro Techniques; D007328:Insulin; D007668:Kidney / Q000502:physiology; D016030:Kidney Transplantation / Q000502:physiology*; D008875:Middle Aged; D009926:Organ Preservation / Q000379:methods*; D019188:Organ Preservation Solutions; D010477:Perfusion / Q000379:methods; D011673:Pulsatile Flow; D011887:Raffinose
D007328:Insulin; D019188:Organ Preservation Solutions; C055206:University of Wisconsin-lactobionate solution; D000493:Allopurinol; D005978:Glutathione; D000241:Adenosine; D011887:Raffinose