Normothermic Ex Vivo Kidney Perfusion for the Preservation of Kidney Grafts prior to Transplantation.
Kidney transplantation has become a well-established treatment option for patients with end-stage renal failure. The persisting organ shortage remains a serious problem. Therefore, the acceptance criteria for organ donors have been extended leading to the usage of marginal kidney grafts. These marginal organs tolerate cold storage poorly resulting in increased preservation injury and higher rates of delayed graft function. To overcome the limitations of cold storage, extensive research is focused on alternative normothermic preservation methods. Ex vivo normothermic organ perfusion is an innovative preservation technique. The first experimental and clinical trials for ex vivo lung, liver, and kidney perfusions demonstrated favorable outcomes. In addition to the reduction of cold ischemic injury, the method of normothermic kidney storage offers the opportunity for organ assessment and repair. This manuscript provides information about kidney retrieval, organ preservation techniques, and isolated ex vivo normothermic kidney perfusion (NEVKP) in a porcine model. Surgical techniques, set up for the perfusion solution and the circuit, potential assessment options, and representative results are demonstrated.
Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital; Division of Nephrology, The Hospital for Sick Children, Toronto; moritz.kaths@gmail.com.
J Moritz
JM
Kaths
Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital.
Vinzent N
VN
Spetzler
Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital.
Nicolas
N
Goldaracena
Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital.
Juan
J
Echeverri
Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital.
Kristine S
KS
Louis
Department of General, Visceral & Transplant Surgery, University Medical Center Mainz.
Daniel B
DB
Foltys
Department of Abdominal, Vascular & Transplant Surgery, Merheim Medical Center Cologne.
Mari
M
Strempel
Laboratory Medicine & Pathobiology, Toronto General Hospital.
Paul
P
Yip
Laboratory Medicine & Pathobiology, Toronto General Hospital.
Rohan
R
John
Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital.
Istvan
I
Mucsi
Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital.
Anand
A
Ghanekar
Departments of Surgery (Urology) & Physiology, The Hospital for Sick Children, Toronto; Developmental & Stem Cell Biology, The Hospital for Sick Children, Toronto.
Darius
D
Bagli
Division of Nephrology, The Hospital for Sick Children, Toronto.
Lisa
L
Robinson
Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital.
Markus
M
Selzner
D000818:Animals; D007668:Kidney; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D023421:Models, Animal; D009926:Organ Preservation / Q000379:methods*; D010477:Perfusion / Q000379:methods; D013552:Swine