Pushing the envelope in renal preservation; improved results with novel perfusate modifications for pulsatile machine perfusion of cadaver kidneys.
BACKGROUND
Novel preservation techniques may diminish ischemia/reperfusion (I/R) injury. Our preservation laboratory has modified Belzer MPS for machine perfusion (MP) with prostaglandin E1 (PGE 1), nitroglycerin (NTG), and polyethylene glycol-superoxide dismutase (PEG-SOD) to attenuate I/R injury. We reviewed our recent experience using this novel formulation (NF) compared with standard perfusates.


RESULTS
Between January 1998 and March 2000, 1060 consecutive kidneys were preserved in our laboratory. One hundred forty-eight kidneys (14%) were discarded. Fifty-eight percent of kidneys during this time period underwent MP (n = 532). En bloc kidney pairs were randomly assigned to pulsatile MP using Waters RM3 or MOX-100 perfusion systems using 1 of 3 perfusates; NF (NF; n = 119), Belzer MPS (MPS; n = 201), or Belzer II albumin gluconate (ALB; n = 212) Significant improvements in delayed graft function (DGF) rate were seen with NF versus other perfusates (8% vs 14% vs 19%, respectively; P =.03). At 6 months, graft survival was significantly improved with NF compared with MPS and ALB (96% vs 90% vs 87%, respectively; P =.03). NF also produced a significantly higher percentage of recipients with a serum creatinine level < or = 1.5 mg/dL.


CONCLUSIONS
Novel modifications of standard MP perfusate improved outcomes after renal transplantation. Preservation-based interventions targeted to ameliorate I/R injury can improve outcomes and may allow expansion of the donor pool.
Guarrera
J V
JV
New York Presbyterian Hospital Organ Preservation Unit, Weill Medical College of Cornell University, New York, USA.
Polyak
M M R
MM
Arrington
B
B
O'Mar Arrington
B
B
Boykin
J
J
Brown
T
T
Jean-Jacques
M A
MA
Kapur
S
S
Stubenbord
W T
WT
Kinkhabwala
M
M
D000328:Adult; D000527:Alprostadil; D002102:Cadaver; D002423:Cause of Death; D005260:Female; D016166:Free Radical Scavengers; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D007668:Kidney; D016030:Kidney Transplantation / Q000502:physiology; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin; D009926:Organ Preservation / Q000379:methods*; D010477:Perfusion / Q000379:methods; D011092:Polyethylene Glycols; D013482:Superoxide Dismutase; D014019:Tissue Donors
D016166:Free Radical Scavengers; D011092:Polyethylene Glycols; D013482:Superoxide Dismutase; C063471:polyethylene glycol-superoxide dismutase; D000527:Alprostadil; D005996:Nitroglycerin