TY - JOUR
T1 - Pushing the envelope in renal preservation
T2 - Improved results with novel perfusate modifications for pulsatile machine perfusion of cadaver kidneys
AU - Guarrera, J. V.
AU - Polyak, M. M.R.
AU - O'Mar Arrington, B.
AU - Boykin, J.
AU - Brown, T.
AU - Jean-Jacques, M. A.
AU - Kapur, S.
AU - Stubenbord, W. T.
AU - Kinkhabwala, M.
PY - 2004/6
Y1 - 2004/6
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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U2 - 10.1016/j.transproceed.2004.04.083
DO - 10.1016/j.transproceed.2004.04.083
M3 - Article
C2 - 15251306
AN - SCOPUS:3142600691
SN - 0041-1345
VL - 36
SP - 1257
EP - 1260
JO - Transplantation proceedings
JF - Transplantation proceedings
IS - 5
ER -