title: Peritoneal cooling may provide improved protection for uncontrolled donors after cardiac death: an exploratory porcine study.
abstract: Uncontrolled donation after cardiac death (DCD) renal transplantation relies on rapid establishment of organ preservation interventions. We have developed a model of the uncontrolled DCD, comparing current in situ perfusion (ISP) techniques with additional peritoneal cooling (PC). Ten pigs were killed and subjected to a 2 h ischemia period. The ISP group modeled current DCD protocols. The PC group (PC) modeled current protocols plus PC. Two animals were used as controls and subjected to 2 h of warm ischemia. Core renal temperature and microdialysis markers of ischemia were measured. Preservation interventions began at 30 min, with rapid laparotomy and kidney recovery performed at 2 h, prior to machine perfusion viability testing. The final mean renal temperature achieved in the ISP group was 26.3 degrees C versus 16.9 degrees C in the PC group (p = 0.0001). A significant cryopreservation benefit was suggested by lower peak microdialysate lactate and glycerol levels (ISP vs. PC, p = 0.0003 and 0.0008), and the superiority of the PC group viability criteria (p = 0.0147). This pilot study has demonstrated significant temperature, ischemia protection and viability assessment benefits with the use of supplementary PC. The data suggests a need for further research to determine the potential for reductions in the rates of ischemia-related clinical phenomena for uncontrolled DCDs.
authors.affiliation: Liver, Renal and Pancreatic Transplant Unit, Freeman Hospital, Newcastle-upon-Tyne, UK. alex@navarro1.wanadoo.co.uk
authors.forename: A P
authors.initials: AP
authors.lastname: Navarro
authors.forename: J
authors.initials: J
authors.lastname: Asher
authors.forename: S
authors.initials: S
authors.lastname: Sohrabi
authors.forename: M
authors.initials: M
authors.lastname: Reddy
authors.forename: S
authors.initials: S
authors.lastname: Stamp
authors.forename: N
authors.initials: N
authors.lastname: Carter
authors.forename: D
authors.initials: D
authors.lastname: Talbot
mesh_terms: D000818:Animals; D003080:Cold Temperature; D003643:Death; D016030:Kidney Transplantation / Q000379:methods; D009926:Organ Preservation / Q000379:methods*; D019188:Organ Preservation Solutions; D010477:Perfusion; D010529:Peritoneal Cavity; D010865:Pilot Projects; D034421:Sus scrofa; D014019:Tissue Donors
chemical_list: D019188:Organ Preservation Solutions