Long-term Transplant Function After Thrombolytic Treatment Ex Vivo of Donated Kidneys Retrieved 4 to 5 Hours After Circulatory Death

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Olausson, MichaelSahlgrenska universitetssjukhuset,Sahlgrenska University Hospital (author)

Long-term Transplant Function After Thrombolytic Treatment Ex Vivo of Donated Kidneys Retrieved 4 to 5 Hours After Circulatory Death

Article/chapterEnglish2022

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2022
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LIBRIS-ID:oai:research.chalmers.se:7e271462-4683-4f1c-ab34-8719fda38581
https://research.chalmers.se/publication/531438URI
https://doi.org/10.1097/TP.0000000000004235DOI

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Language:English
Summary in:English

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Background. Using a novel thrombolytic technique, we present long-term transplant function, measured by creatinine and iohexol clearance, after utilizing kidneys from porcine donors with uncontrolled donation after circulatory deaths, with 4.5–5 h of warm ischemia. Methods. Pigs in the study group were subjected to simulated circulatory death. After 2 h, ice slush was inserted into the abdomen and 4.5 h after death, the kidneys were retrieved. Lys-plasminogen, antithrombin-III, and alteplase were injected through the renal arteries on the back table. Subsequent ex vivo perfusion was continued for 3 h at 15°C, followed by 3 h with red blood cells at 32°C, and then transplanted into pigs as an autologous graft as only renal support. Living-donor recipient pigs that did not receive ex vivo perfusion, and unilateral nephrectomized pigs served as the controls. Results. Pigs in the study group (n = 13), surviving 10 d or more were included, of which 7 survived for 3 mo. Four animals in the living-donor group (n = 6) and all 5 nephrectomized animals survived for 3 mo. Creatinine levels in the plasma and urine, neutrophil gelatinase-associated lipocalin levels, Kidney Injury Marker-1 expression, and iohexol clearance at 3 mo did not differ significantly between the study and living-donor groups. Histology and transmission electron microscopy after 3 mo showed negligible fibrosis and no other damage. Conclusions. The present method salvages kidneys from extended unontrolled donation after circulatory death using thrombolytic treatment while preserving histology and enabling transplantation after ex vivo reconditioning, with clinically acceptable late function after 3 mo, as measured by creatinine and iohexol clearance.

Subject headings and genre

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine hsv//eng
MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Urologi och njurmedicin hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Urology and Nephrology hsv//eng

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Antony, DeeptiSahlgrenska universitetssjukhuset,Sahlgrenska University Hospital (author)
Johansson, MartinSahlgrenska universitetssjukhuset,Sahlgrenska University Hospital (author)
Travnikova, GalinaSahlgrenska universitetssjukhuset,Sahlgrenska University Hospital (author)
Nayakawde, NikhilSahlgrenska universitetssjukhuset,Sahlgrenska University Hospital (author)
Banerjee, DebashishSahlgrenska universitetssjukhuset,Sahlgrenska University Hospital (author)
Söfteland, John MSahlgrenska universitetssjukhuset,Sahlgrenska University Hospital (author)
Ognissanti, Damiano,1990Chalmers tekniska högskola,Chalmers University of Technology(Swepub:cth)damiano (author)
Andresen Bergstrom, MoaSahlgrenska universitetssjukhuset,Sahlgrenska University Hospital (author)
Hammarsten, OlaSahlgrenska universitetssjukhuset,Sahlgrenska University Hospital (author)
Premaratne, Goditha U.Sahlgrenska universitetssjukhuset,Sahlgrenska University Hospital (author)
Sahlgrenska universitetssjukhusetChalmers tekniska högskola (creator_code:org_t)

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In:Transplantation106:12, s. 2348-23590041-1337

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