Pushing the envelope in renal preservation

Improved results with novel perfusate modifications for pulsatile machine perfusion of cadaver kidneys

J. V. Guarrera, M. M R Polyak, B. O'Mar Arrington, J. Boykin, T. Brown, M. A. Jean-Jacques, S. Kapur, W. T. Stubenbord, Milan Kinkhabwala

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Introduction Novel preservation techniques may diminish ischemia/reperfusion (I/R) injury. Our preservation laboratory has modified Belzer MPS for machine perfusion (MP) with prostaglandin E1 (PGE 1), nitroglycerin (NTG), and polyethylene glycol-superoxide dismutase (PEG-SOD) to attenuate I/R injury. We reviewed our recent experience using this novel formulation (NF) compared with standard perfusates. Results Between January 1998 and March 2000, 1060 consecutive kidneys were preserved in our laboratory. One hundred forty-eight kidneys (14%) were discarded. Fifty-eight percent of kidneys during this time period underwent MP (n = 532). En bloc kidney pairs were randomly assigned to pulsatile MP using Waters RM3 or MOX-100 perfusion systems using 1 of 3 perfusates; NF (NF; n = 119), Belzer MPS (MPS; n = 201), or Belzer II albumin gluconate (ALB; n = 212) Significant improvements in delayed graft function (DGF) rate were seen with NF versus other perfusates (8% vs 14% vs 19%, respectively; P = .03). At 6 months, graft survival was significantly improved with NF compared with MPS and ALB (96% vs 90% vs 87%, respectively; P = .03). NF also produced a significantly higher percentage of recipients with a serum creatinine level ≤1.5 mg/dL. Conclusions Novel modifications of standard MP perfusate improved outcomes after renal transplantation. Preservation-based interventions targeted to ameliorate I/R injury can improve outcomes and may allow expansion of the donor pool.

Original languageEnglish (US)
Pages (from-to)1257-1260
Number of pages4
JournalTransplantation Proceedings
Volume36
Issue number5
DOIs
StatePublished - Jun 2004
Externally publishedYes

Fingerprint

Pulsatile Flow
Cadaver
Perfusion
Reperfusion Injury
Kidney
Delayed Graft Function
Alprostadil
Nitroglycerin
Graft Survival
Kidney Transplantation
Albumins
Creatinine
Water
Serum

ASJC Scopus subject areas

  • Surgery
  • Transplantation

Cite this

Pushing the envelope in renal preservation : Improved results with novel perfusate modifications for pulsatile machine perfusion of cadaver kidneys. / Guarrera, J. V.; Polyak, M. M R; O'Mar Arrington, B.; Boykin, J.; Brown, T.; Jean-Jacques, M. A.; Kapur, S.; Stubenbord, W. T.; Kinkhabwala, Milan.

In: Transplantation Proceedings, Vol. 36, No. 5, 06.2004, p. 1257-1260.

Research output: Contribution to journalArticle

Guarrera, J. V. ; Polyak, M. M R ; O'Mar Arrington, B. ; Boykin, J. ; Brown, T. ; Jean-Jacques, M. A. ; Kapur, S. ; Stubenbord, W. T. ; Kinkhabwala, Milan. / Pushing the envelope in renal preservation : Improved results with novel perfusate modifications for pulsatile machine perfusion of cadaver kidneys. In: Transplantation Proceedings. 2004 ; Vol. 36, No. 5. pp. 1257-1260.
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abstract = "Introduction Novel preservation techniques may diminish ischemia/reperfusion (I/R) injury. Our preservation laboratory has modified Belzer MPS for machine perfusion (MP) with prostaglandin E1 (PGE 1), nitroglycerin (NTG), and polyethylene glycol-superoxide dismutase (PEG-SOD) to attenuate I/R injury. We reviewed our recent experience using this novel formulation (NF) compared with standard perfusates. Results Between January 1998 and March 2000, 1060 consecutive kidneys were preserved in our laboratory. One hundred forty-eight kidneys (14{\%}) were discarded. Fifty-eight percent of kidneys during this time period underwent MP (n = 532). En bloc kidney pairs were randomly assigned to pulsatile MP using Waters RM3 or MOX-100 perfusion systems using 1 of 3 perfusates; NF (NF; n = 119), Belzer MPS (MPS; n = 201), or Belzer II albumin gluconate (ALB; n = 212) Significant improvements in delayed graft function (DGF) rate were seen with NF versus other perfusates (8{\%} vs 14{\%} vs 19{\%}, respectively; P = .03). At 6 months, graft survival was significantly improved with NF compared with MPS and ALB (96{\%} vs 90{\%} vs 87{\%}, respectively; P = .03). NF also produced a significantly higher percentage of recipients with a serum creatinine level ≤1.5 mg/dL. Conclusions Novel modifications of standard MP perfusate improved outcomes after renal transplantation. Preservation-based interventions targeted to ameliorate I/R injury can improve outcomes and may allow expansion of the donor pool.",
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AU - O'Mar Arrington, B.

AU - Boykin, J.

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N2 - Introduction Novel preservation techniques may diminish ischemia/reperfusion (I/R) injury. Our preservation laboratory has modified Belzer MPS for machine perfusion (MP) with prostaglandin E1 (PGE 1), nitroglycerin (NTG), and polyethylene glycol-superoxide dismutase (PEG-SOD) to attenuate I/R injury. We reviewed our recent experience using this novel formulation (NF) compared with standard perfusates. Results Between January 1998 and March 2000, 1060 consecutive kidneys were preserved in our laboratory. One hundred forty-eight kidneys (14%) were discarded. Fifty-eight percent of kidneys during this time period underwent MP (n = 532). En bloc kidney pairs were randomly assigned to pulsatile MP using Waters RM3 or MOX-100 perfusion systems using 1 of 3 perfusates; NF (NF; n = 119), Belzer MPS (MPS; n = 201), or Belzer II albumin gluconate (ALB; n = 212) Significant improvements in delayed graft function (DGF) rate were seen with NF versus other perfusates (8% vs 14% vs 19%, respectively; P = .03). At 6 months, graft survival was significantly improved with NF compared with MPS and ALB (96% vs 90% vs 87%, respectively; P = .03). NF also produced a significantly higher percentage of recipients with a serum creatinine level ≤1.5 mg/dL. Conclusions Novel modifications of standard MP perfusate improved outcomes after renal transplantation. Preservation-based interventions targeted to ameliorate I/R injury can improve outcomes and may allow expansion of the donor pool.

AB - Introduction Novel preservation techniques may diminish ischemia/reperfusion (I/R) injury. Our preservation laboratory has modified Belzer MPS for machine perfusion (MP) with prostaglandin E1 (PGE 1), nitroglycerin (NTG), and polyethylene glycol-superoxide dismutase (PEG-SOD) to attenuate I/R injury. We reviewed our recent experience using this novel formulation (NF) compared with standard perfusates. Results Between January 1998 and March 2000, 1060 consecutive kidneys were preserved in our laboratory. One hundred forty-eight kidneys (14%) were discarded. Fifty-eight percent of kidneys during this time period underwent MP (n = 532). En bloc kidney pairs were randomly assigned to pulsatile MP using Waters RM3 or MOX-100 perfusion systems using 1 of 3 perfusates; NF (NF; n = 119), Belzer MPS (MPS; n = 201), or Belzer II albumin gluconate (ALB; n = 212) Significant improvements in delayed graft function (DGF) rate were seen with NF versus other perfusates (8% vs 14% vs 19%, respectively; P = .03). At 6 months, graft survival was significantly improved with NF compared with MPS and ALB (96% vs 90% vs 87%, respectively; P = .03). NF also produced a significantly higher percentage of recipients with a serum creatinine level ≤1.5 mg/dL. Conclusions Novel modifications of standard MP perfusate improved outcomes after renal transplantation. Preservation-based interventions targeted to ameliorate I/R injury can improve outcomes and may allow expansion of the donor pool.

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