25 February 2020 : Original article
Effects of Delayed Hypothermic Machine Perfusion on Kidney Grafts with a Preliminary Period of Static Cold Storage and a Total Cold Ischemia Time of Over 24 Hours
Gian Luigi Adani1AE*, Riccardo Pravisani1ACE, Sara Crestale1B, Umberto Baccarani1F, Cathryn A. Scott2B, Lorenzo D’Alì2B, Giovanna DeMaglio3B, Patrizia Tulissi4BD, Clotilde Vallone4B, Miriam Isola5C, Elda Righi6F, Stefano Pizzolito3F, Carla Di Loreto2DF, Andrea Risaliti1FDOI: 10.12659/AOT.918997
Ann Transplant 2020; 25:e918997
Abstract
BACKGROUND: Hypothermic machine perfusion (HMP) appears to exert a reconditioning effect on the ischemic damage of kidney grafts. However, some concerns still remain about its real effectiveness when it is delayed after a preliminary period of static cold storage (SCS) or with prolonged overall cold ischemia time (CIT).
MATERIAL AND METHODS: The effect of HMP on hemodynamic, metabolic, histological and ultrastructural features of grafts was investigated in 21 single-kidney grafts treated with a delayed HMP after SCS and with a total CIT of over 24 h.
RESULTS: The mean CIT, SCS, and HMP times were 29 h, 12 h, and 18 h, respectively. Longer SCS was associated with higher vascular resistance and lower arterial flow. In the pre- vs. post-HMP comparison, a significant decrease in arterial resistances and increase of flow were recorded. The hemodynamic improvement was independent of HMP duration. The perfused grafts retained some metabolic activity, with a statistically significant decrease of pH, pO2, and glucose levels, and increase of lactates in the perfusion liquid, by the end of HMP. Longer SCS was associated with higher pH and greater pO2 decrease during HMP. Light microscopy and transmission electronic microscopy revealed no significant variations in nuclear, cytoplasmic, or ultrastructural damage. SCS, HMP, and CIT were not identified as risk factor for delayed graft function or rejection.
CONCLUSIONS: A delayed and extended HMP can recover the graft hemodynamic function, maintain some metabolic activity, and stabilize the accumulated ischemic damage due to a preliminary SCS.
Keywords: cold ischemia, Kidney Transplantation, Kidneys, Artificial, Cryopreservation, Graft Survival, Hemodynamics, Hypothermia, Induced, Kidney, Organ Preservation, Perfusion, Time Factors, Vascular Resistance
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