title: Early experience with hypothermic machine perfusion of living donor kidneys - a retrospective study.
abstract: Although hypothermic machine perfusion (HMP) has been shown to be beneficial to deceased donor kidneys, the effect of HMP on living donor kidneys (LDK) is unknown. LDK are subjected to minutes of normothermic ischemia at the time of recovery. Comparison of 16 LDK preserved by HMP with 16 LDK preserved by static cold storage (SCS). Outcomes of interest are resistive indices (RI), both while on HMP and postoperatively, and creatinine clearance (CrCl). Injury markers NGAL and LDH were seen in the perfusate of LDK in amounts similar to what is found for donation after neurological determination of death kidneys. Compared to SCS kidneys, CrCl was significantly higher in the HMP group from days 2 through 7 post-transplant [ie: day 7 (78.8 ± 5.4 vs. 54.0 ± 4.6 ml/min, P = 0.005)]. CrCl at 1 year was higher in the HMP group (81.2 ± 5.8 vs. 70.0 ± 5.3 ml/min, P = 0.03). Early post-transplant RI was significantly lower in the HMP group (0.61 ± 0.02 vs. 0.71 ± 0.02, P < 0.0001). Our data support the assertion that injury does occur during LDK procurement and suggest that some of this injury may be reversed with HMP, resulting in more favorable early RI and graft function compared to SCS kidneys.
authors.affiliation: Department of Surgery, University of Saskatchewan, Saskatoon, SK, Canada.|Saskatchewan Renal Transplant Program, Saskatoon, SK, Canada.
authors.forename: Michael A J
authors.identifier: http://orcid.org/0000-0003-0735-199X
authors.initials: MAJ
authors.lastname: Moser
authors.affiliation: Department of Surgery, University of Saskatchewan, Saskatoon, SK, Canada.
authors.forename: Nathan
authors.initials: N
authors.lastname: Ginther
authors.affiliation: Department of Surgery, University of Saskatchewan, Saskatoon, SK, Canada.|Saskatchewan Renal Transplant Program, Saskatoon, SK, Canada.
authors.forename: Yigang
authors.initials: Y
authors.lastname: Luo
authors.affiliation: Department of Surgery, University of Saskatchewan, Saskatoon, SK, Canada.|Saskatchewan Renal Transplant Program, Saskatoon, SK, Canada.
authors.forename: Gavin
authors.initials: G
authors.lastname: Beck
authors.affiliation: Saskatchewan Renal Transplant Program, Saskatoon, SK, Canada.
authors.forename: Ronn
authors.initials: R
authors.lastname: Ginther
authors.affiliation: Saskatchewan Renal Transplant Program, Saskatoon, SK, Canada.
authors.forename: Marla
authors.initials: M
authors.lastname: Ewen
authors.affiliation: Saskatchewan Renal Transplant Program, Saskatoon, SK, Canada.
authors.forename: Rhianna
authors.initials: R
authors.lastname: Matsche-Neufeld
authors.affiliation: Saskatchewan Renal Transplant Program, Saskatoon, SK, Canada.|Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Shoker
authors.affiliation: Department of Pharmacology, University of Saskatchewan, Saskatoon, SK, Canada.|Department of Clinical Chemistry, Medical University of Wroclaw, Wroclaw, Poland.
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Sawicki
mesh_terms: D000328:Adult; D050377:Cold Ischemia; D003080:Cold Temperature; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007668:Kidney / Q000502:physiology; D016030:Kidney Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation / Q000295:instrumentation / Q000379:methods*; D010477:Perfusion / Q000295:instrumentation / Q000379:methods; D012189:Retrospective Studies; D052096:Warm Ischemia
chemical_list: D003404:Creatinine
keywords: ischemia reperfusion injury; kidney; living donor; organ preservation and procurement