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Improved outcomes in cadaveric renal allografts with pulsatile preservation
Background: Early immunologic and non‐immunologic injury of renal allografts adversely affects long‐term graft survival. Some degree of preservation injury is inevitable in cadaveric renal transplantation, and, with the reduction in early acute rejection, this non‐immunologic injury has assumed a gr...
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| Published in: | Clinical transplantation 2000-12, Vol.14 (6), p.543-549 |
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| container_issue | 6 |
| container_start_page | 543 |
| container_title | Clinical transplantation |
| container_volume | 14 |
| creator | Sellers, Marty T Gallichio, Michael H Hudson, Sharon L Young, Carlton J Bynon, J Stevenson Eckhoff, Devin E Deierhoi, Mark H Diethelm, Arnold G Thompson, J Anthony |
| description | Background: Early immunologic and non‐immunologic injury of renal allografts adversely affects long‐term graft survival. Some degree of preservation injury is inevitable in cadaveric renal transplantation, and, with the reduction in early acute rejection, this non‐immunologic injury has assumed a greater relative importance. Optimal graft preservation will maximize the chances of early graft function and long‐term graft survival, but the best method of preservation – pulsatile perfusion (PP) versus cold storage (CS) – is debated.
Methods: Primary cadaveric kidney recipients from January 1990 through December 1995 were evaluated. The effects of implantation warm ischemic time (WIT) (≤20 min, 21–40 min, or >40 min) and total ischemic time (TIT) (< or ≥20 h) on death‐censored graft survival were compared between kidneys preserved by PP versus those preserved by CS. The effect of preservation method on delayed graft function (DGF) was also examined.
Results: There were 568 PP kidneys and 268 CS kidneys. Overall death‐censored graft survival was not significantly different between groups, despite worse donor and recipient characteristics in the PP group. CS kidneys with an implantation WIT >40 min had worse graft survival than those with |
| doi_str_mv | 10.1034/j.1399-0012.2000.140605.x |
| format | article |
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Methods: Primary cadaveric kidney recipients from January 1990 through December 1995 were evaluated. The effects of implantation warm ischemic time (WIT) (≤20 min, 21–40 min, or >40 min) and total ischemic time (TIT) (< or ≥20 h) on death‐censored graft survival were compared between kidneys preserved by PP versus those preserved by CS. The effect of preservation method on delayed graft function (DGF) was also examined.
Results: There were 568 PP kidneys and 268 CS kidneys. Overall death‐censored graft survival was not significantly different between groups, despite worse donor and recipient characteristics in the PP group. CS kidneys with an implantation WIT >40 min had worse graft survival than those with <40 min (p=0.0004). Survival of PP kidneys and those transplanted into 2 DR‐matched recipients was not affected by longer implantation WIT. Longer TIT did not impact survival. DGF was more likely after CS preservation (20.2% versus 8.8%, p=0.001).
Conclusions: Preservation with PP improves early graft function and lessens the adverse effect of increased warm ischemia in cadaveric renal transplantation. This method is likely associated with less preservation injury and/or increases the threshold for injury from other sources and is superior to CS.</description><identifier>ISSN: 0902-0063</identifier><identifier>EISSN: 1399-0012</identifier><identifier>DOI: 10.1034/j.1399-0012.2000.140605.x</identifier><identifier>PMID: 11127306</identifier><language>eng</language><publisher>Copenhagen: Munksgaard International Publishers</publisher><subject>Adenosine ; Adult ; Allopurinol ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Cadaver ; Cardioplegic Solutions ; Clinical death. Palliative care. Organ gift and preservation ; Cold Temperature ; Follow-Up Studies ; Glutathione ; Graft Survival ; Humans ; Insulin ; ischemia ; Kidney Transplantation ; Medical sciences ; Organ Preservation - methods ; Organ Preservation Solutions ; preservation ; Pulsatile Flow ; Raffinose</subject><ispartof>Clinical transplantation, 2000-12, Vol.14 (6), p.543-549</ispartof><rights>2001 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4365-3b300997671a9c80d8079d34e0540498d5aa795d16a75673a718d483d1d1fd1f3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=810368$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11127306$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sellers, Marty T</creatorcontrib><creatorcontrib>Gallichio, Michael H</creatorcontrib><creatorcontrib>Hudson, Sharon L</creatorcontrib><creatorcontrib>Young, Carlton J</creatorcontrib><creatorcontrib>Bynon, J Stevenson</creatorcontrib><creatorcontrib>Eckhoff, Devin E</creatorcontrib><creatorcontrib>Deierhoi, Mark H</creatorcontrib><creatorcontrib>Diethelm, Arnold G</creatorcontrib><creatorcontrib>Thompson, J Anthony</creatorcontrib><title>Improved outcomes in cadaveric renal allografts with pulsatile preservation</title><title>Clinical transplantation</title><addtitle>Clin Transplantation</addtitle><description>Background: Early immunologic and non‐immunologic injury of renal allografts adversely affects long‐term graft survival. Some degree of preservation injury is inevitable in cadaveric renal transplantation, and, with the reduction in early acute rejection, this non‐immunologic injury has assumed a greater relative importance. Optimal graft preservation will maximize the chances of early graft function and long‐term graft survival, but the best method of preservation – pulsatile perfusion (PP) versus cold storage (CS) – is debated.
Methods: Primary cadaveric kidney recipients from January 1990 through December 1995 were evaluated. The effects of implantation warm ischemic time (WIT) (≤20 min, 21–40 min, or >40 min) and total ischemic time (TIT) (< or ≥20 h) on death‐censored graft survival were compared between kidneys preserved by PP versus those preserved by CS. The effect of preservation method on delayed graft function (DGF) was also examined.
Results: There were 568 PP kidneys and 268 CS kidneys. Overall death‐censored graft survival was not significantly different between groups, despite worse donor and recipient characteristics in the PP group. CS kidneys with an implantation WIT >40 min had worse graft survival than those with <40 min (p=0.0004). Survival of PP kidneys and those transplanted into 2 DR‐matched recipients was not affected by longer implantation WIT. Longer TIT did not impact survival. DGF was more likely after CS preservation (20.2% versus 8.8%, p=0.001).
Conclusions: Preservation with PP improves early graft function and lessens the adverse effect of increased warm ischemia in cadaveric renal transplantation. This method is likely associated with less preservation injury and/or increases the threshold for injury from other sources and is superior to CS.</description><subject>Adenosine</subject><subject>Adult</subject><subject>Allopurinol</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Cadaver</subject><subject>Cardioplegic Solutions</subject><subject>Clinical death. Palliative care. Organ gift and preservation</subject><subject>Cold Temperature</subject><subject>Follow-Up Studies</subject><subject>Glutathione</subject><subject>Graft Survival</subject><subject>Humans</subject><subject>Insulin</subject><subject>ischemia</subject><subject>Kidney Transplantation</subject><subject>Medical sciences</subject><subject>Organ Preservation - methods</subject><subject>Organ Preservation Solutions</subject><subject>preservation</subject><subject>Pulsatile Flow</subject><subject>Raffinose</subject><issn>0902-0063</issn><issn>1399-0012</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2000</creationdate><recordtype>article</recordtype><recordid>eNqNkF1r2zAUhsVYWdNuf6G4DHrn7MiyJOuuI6wfLHRQsu1SnEpy50y2M8lO038_BYfsdiCQdPSc94iHkEsKcwqs_LSeU6ZUDkCLeQGQqiUI4PPdGzI7vrwlM1BQpLNgp-QsxnWqCir4O3JKKS0kAzEjX-_bTei3zmb9OJi-dTFrusygxa0LjcmC69Bn6H3_HLAeYvbSDL-yzegjDo132Sa46MI2XfruPTmp0Uf34bCfk-83X1aLu3z57fZ-8XmZm5IJnrMnBqCUFJKiMhXYCqSyrHTASyhVZTmiVNxSgZILyVDSypYVs9TSOi12Tq6m3PTzP6OLg26baJz32Ll-jFoWpeJQqASqCTShjzG4Wm9C02J41RT03qRe670vvfel9yb1ZFLvUu_FYcj41Dr7r_OgLgEfDwBGg74O2JkmHrkq5YsqUdcT9ZJsvf7_fL1YPU7nFJFPEU0c3O4YgeG3TnYk1z8fbvVSLu9W1eON_sH-Am_ynYU</recordid><startdate>200012</startdate><enddate>200012</enddate><creator>Sellers, Marty T</creator><creator>Gallichio, Michael H</creator><creator>Hudson, Sharon L</creator><creator>Young, Carlton J</creator><creator>Bynon, J Stevenson</creator><creator>Eckhoff, Devin E</creator><creator>Deierhoi, Mark H</creator><creator>Diethelm, Arnold G</creator><creator>Thompson, J Anthony</creator><general>Munksgaard International Publishers</general><general>Blackwell</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200012</creationdate><title>Improved outcomes in cadaveric renal allografts with pulsatile preservation</title><author>Sellers, Marty T ; Gallichio, Michael H ; Hudson, Sharon L ; Young, Carlton J ; Bynon, J Stevenson ; Eckhoff, Devin E ; Deierhoi, Mark H ; Diethelm, Arnold G ; Thompson, J Anthony</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4365-3b300997671a9c80d8079d34e0540498d5aa795d16a75673a718d483d1d1fd1f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2000</creationdate><topic>Adenosine</topic><topic>Adult</topic><topic>Allopurinol</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Cadaver</topic><topic>Cardioplegic Solutions</topic><topic>Clinical death. Palliative care. Organ gift and preservation</topic><topic>Cold Temperature</topic><topic>Follow-Up Studies</topic><topic>Glutathione</topic><topic>Graft Survival</topic><topic>Humans</topic><topic>Insulin</topic><topic>ischemia</topic><topic>Kidney Transplantation</topic><topic>Medical sciences</topic><topic>Organ Preservation - methods</topic><topic>Organ Preservation Solutions</topic><topic>preservation</topic><topic>Pulsatile Flow</topic><topic>Raffinose</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sellers, Marty T</creatorcontrib><creatorcontrib>Gallichio, Michael H</creatorcontrib><creatorcontrib>Hudson, Sharon L</creatorcontrib><creatorcontrib>Young, Carlton J</creatorcontrib><creatorcontrib>Bynon, J Stevenson</creatorcontrib><creatorcontrib>Eckhoff, Devin E</creatorcontrib><creatorcontrib>Deierhoi, Mark H</creatorcontrib><creatorcontrib>Diethelm, Arnold G</creatorcontrib><creatorcontrib>Thompson, J Anthony</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sellers, Marty T</au><au>Gallichio, Michael H</au><au>Hudson, Sharon L</au><au>Young, Carlton J</au><au>Bynon, J Stevenson</au><au>Eckhoff, Devin E</au><au>Deierhoi, Mark H</au><au>Diethelm, Arnold G</au><au>Thompson, J Anthony</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Improved outcomes in cadaveric renal allografts with pulsatile preservation</atitle><jtitle>Clinical transplantation</jtitle><addtitle>Clin Transplantation</addtitle><date>2000-12</date><risdate>2000</risdate><volume>14</volume><issue>6</issue><spage>543</spage><epage>549</epage><pages>543-549</pages><issn>0902-0063</issn><eissn>1399-0012</eissn><abstract>Background: Early immunologic and non‐immunologic injury of renal allografts adversely affects long‐term graft survival. Some degree of preservation injury is inevitable in cadaveric renal transplantation, and, with the reduction in early acute rejection, this non‐immunologic injury has assumed a greater relative importance. Optimal graft preservation will maximize the chances of early graft function and long‐term graft survival, but the best method of preservation – pulsatile perfusion (PP) versus cold storage (CS) – is debated.
Methods: Primary cadaveric kidney recipients from January 1990 through December 1995 were evaluated. The effects of implantation warm ischemic time (WIT) (≤20 min, 21–40 min, or >40 min) and total ischemic time (TIT) (< or ≥20 h) on death‐censored graft survival were compared between kidneys preserved by PP versus those preserved by CS. The effect of preservation method on delayed graft function (DGF) was also examined.
Results: There were 568 PP kidneys and 268 CS kidneys. Overall death‐censored graft survival was not significantly different between groups, despite worse donor and recipient characteristics in the PP group. CS kidneys with an implantation WIT >40 min had worse graft survival than those with <40 min (p=0.0004). Survival of PP kidneys and those transplanted into 2 DR‐matched recipients was not affected by longer implantation WIT. Longer TIT did not impact survival. DGF was more likely after CS preservation (20.2% versus 8.8%, p=0.001).
Conclusions: Preservation with PP improves early graft function and lessens the adverse effect of increased warm ischemia in cadaveric renal transplantation. This method is likely associated with less preservation injury and/or increases the threshold for injury from other sources and is superior to CS.</abstract><cop>Copenhagen</cop><pub>Munksgaard International Publishers</pub><pmid>11127306</pmid><doi>10.1034/j.1399-0012.2000.140605.x</doi><tpages>7</tpages></addata></record> |
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| subjects | Adenosine Adult Allopurinol Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Cadaver Cardioplegic Solutions Clinical death. Palliative care. Organ gift and preservation Cold Temperature Follow-Up Studies Glutathione Graft Survival Humans Insulin ischemia Kidney Transplantation Medical sciences Organ Preservation - methods Organ Preservation Solutions preservation Pulsatile Flow Raffinose |
| title | Improved outcomes in cadaveric renal allografts with pulsatile preservation |
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