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Normothermic machine perfusion for the assessment and transplantation of declined human kidneys from donation after circulatory death donors
Background A significant proportion of donation after circulatory death (DCD) kidneys are declined for transplantation because of concerns over their quality. Ex vivo normothermic machine perfusion (NMP) provides a unique opportunity to assess the quality of a kidney and determine its suitability fo...
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| Published in: | British journal of surgery 2018-03, Vol.105 (4), p.388-394 |
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| Main Authors: | , , , , |
| Format: | Article |
| Language: | English |
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| container_end_page | 394 |
| container_issue | 4 |
| container_start_page | 388 |
| container_title | British journal of surgery |
| container_volume | 105 |
| creator | Hosgood, S. A. Thompson, E. Moore, T. Wilson, C. H. Nicholson, M. L. |
| description | Background
A significant proportion of donation after circulatory death (DCD) kidneys are declined for transplantation because of concerns over their quality. Ex vivo normothermic machine perfusion (NMP) provides a unique opportunity to assess the quality of a kidney and determine its suitability for transplantation.
Methods
In phase 1 of this study, declined human DCD kidneys underwent NMP assessment for 60 min. Kidneys were graded 1–5 using a quality assessment score (QAS) based on macroscopic perfusion, renal blood flow and urine output during NMP. In phase 2 of the study, declined DCD kidneys were assessed by NMP with an intention to transplant them.
Results
In phase 1, 18 of 42 DCD kidneys were declined owing to poor in situ perfusion. After NMP, 28 kidneys had a QAS of 1–3, and were considered suitable for transplantation. In phase 2, ten of 55 declined DCD kidneys underwent assessment by NMP. Eight kidneys had been declined because of poor in situ flushing in the donor and five of these were transplanted successfully. Four of the five kidneys had initial graft function.
Conclusion
NMP technology can be used to increase the number of DCD kidney transplants by assessing their quality before transplantation.
Increases available kidneys |
| doi_str_mv | 10.1002/bjs.10733 |
| format | article |
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A significant proportion of donation after circulatory death (DCD) kidneys are declined for transplantation because of concerns over their quality. Ex vivo normothermic machine perfusion (NMP) provides a unique opportunity to assess the quality of a kidney and determine its suitability for transplantation.
Methods
In phase 1 of this study, declined human DCD kidneys underwent NMP assessment for 60 min. Kidneys were graded 1–5 using a quality assessment score (QAS) based on macroscopic perfusion, renal blood flow and urine output during NMP. In phase 2 of the study, declined DCD kidneys were assessed by NMP with an intention to transplant them.
Results
In phase 1, 18 of 42 DCD kidneys were declined owing to poor in situ perfusion. After NMP, 28 kidneys had a QAS of 1–3, and were considered suitable for transplantation. In phase 2, ten of 55 declined DCD kidneys underwent assessment by NMP. Eight kidneys had been declined because of poor in situ flushing in the donor and five of these were transplanted successfully. Four of the five kidneys had initial graft function.
Conclusion
NMP technology can be used to increase the number of DCD kidney transplants by assessing their quality before transplantation.
Increases available kidneys</description><identifier>ISSN: 0007-1323</identifier><identifier>EISSN: 1365-2168</identifier><identifier>DOI: 10.1002/bjs.10733</identifier><identifier>PMID: 29210064</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Ltd</publisher><subject>Adult ; Aged ; Death ; Donor Selection ; Female ; Humans ; Kidney - blood supply ; Kidney - physiology ; Kidney Transplantation ; Kidneys ; Male ; Middle Aged ; Organ Preservation - methods ; Original ; Outcome Assessment (Health Care) ; Perfusion - methods ; Temperature ; Transplants & implants</subject><ispartof>British journal of surgery, 2018-03, Vol.105 (4), p.388-394</ispartof><rights>2017 The Authors. published by John Wiley & Sons Ltd on behalf of BJS Society Ltd.</rights><rights>2017 The Authors. BJS published by John Wiley & Sons Ltd on behalf of BJS Society Ltd.</rights><rights>Copyright © 2018 BJS Society Ltd. Published by John Wiley & Sons, Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4093-4ef41762aecb61d50f1143f60ab1e2d33cfd6d0f36efa740a2c4b8ecd043590a3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27923,27924</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29210064$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hosgood, S. A.</creatorcontrib><creatorcontrib>Thompson, E.</creatorcontrib><creatorcontrib>Moore, T.</creatorcontrib><creatorcontrib>Wilson, C. H.</creatorcontrib><creatorcontrib>Nicholson, M. L.</creatorcontrib><title>Normothermic machine perfusion for the assessment and transplantation of declined human kidneys from donation after circulatory death donors</title><title>British journal of surgery</title><addtitle>Br J Surg</addtitle><description>Background
A significant proportion of donation after circulatory death (DCD) kidneys are declined for transplantation because of concerns over their quality. Ex vivo normothermic machine perfusion (NMP) provides a unique opportunity to assess the quality of a kidney and determine its suitability for transplantation.
Methods
In phase 1 of this study, declined human DCD kidneys underwent NMP assessment for 60 min. Kidneys were graded 1–5 using a quality assessment score (QAS) based on macroscopic perfusion, renal blood flow and urine output during NMP. In phase 2 of the study, declined DCD kidneys were assessed by NMP with an intention to transplant them.
Results
In phase 1, 18 of 42 DCD kidneys were declined owing to poor in situ perfusion. After NMP, 28 kidneys had a QAS of 1–3, and were considered suitable for transplantation. In phase 2, ten of 55 declined DCD kidneys underwent assessment by NMP. Eight kidneys had been declined because of poor in situ flushing in the donor and five of these were transplanted successfully. Four of the five kidneys had initial graft function.
Conclusion
NMP technology can be used to increase the number of DCD kidney transplants by assessing their quality before transplantation.
Increases available kidneys</description><subject>Adult</subject><subject>Aged</subject><subject>Death</subject><subject>Donor Selection</subject><subject>Female</subject><subject>Humans</subject><subject>Kidney - blood supply</subject><subject>Kidney - physiology</subject><subject>Kidney Transplantation</subject><subject>Kidneys</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Organ Preservation - methods</subject><subject>Original</subject><subject>Outcome Assessment (Health Care)</subject><subject>Perfusion - methods</subject><subject>Temperature</subject><subject>Transplants & implants</subject><issn>0007-1323</issn><issn>1365-2168</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><recordid>eNpdks1u1TAQhS0EoreFBS-ALLFhEzr-iZNskGgFBVTBAlhbjn-IL4l9sR3QfQceGt_eUgErj3S-OZoZH4SeEHhBAOj5uM216Bi7hzaEibahRPT30QYAuoYwyk7Qac5bAMKgpQ_RCR1obRR8g359iGmJZbJp8RovSk8-WLyzya3Zx4BdTLiqWOVsc15sKFgFg0tSIe9mFYoqByw6bKyea6_B07qogL95E-w-Y5figk0MR065YhPWPul1ViWmfW1TZToAMeVH6IFTc7aPb98z9OXN68-Xb5vrj1fvLl9dN5rDwBpuHSedoMrqURDTgiOEMydAjcRSw5h2RhhwTFinOg6Kaj72VhvgrB1AsTP08ui7W8fFGl23SmqWu-QXlfYyKi__VYKf5Nf4Q7Z93w1dVw2e3xqk-H21ucjFZ23nehAb1yzJ0DEuCGtpRZ_9h27jmkJdT1KAvmcgBl6pp39PdDfKn4-qwPkR-Olnu7_TCchDAmRNgLxJgLx4_-mmYL8B0OannA</recordid><startdate>201803</startdate><enddate>201803</enddate><creator>Hosgood, S. A.</creator><creator>Thompson, E.</creator><creator>Moore, T.</creator><creator>Wilson, C. H.</creator><creator>Nicholson, M. L.</creator><general>John Wiley & Sons, Ltd</general><general>Oxford University Press</general><scope>24P</scope><scope>WIN</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>201803</creationdate><title>Normothermic machine perfusion for the assessment and transplantation of declined human kidneys from donation after circulatory death donors</title><author>Hosgood, S. A. ; Thompson, E. ; Moore, T. ; Wilson, C. H. ; Nicholson, M. L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4093-4ef41762aecb61d50f1143f60ab1e2d33cfd6d0f36efa740a2c4b8ecd043590a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Death</topic><topic>Donor Selection</topic><topic>Female</topic><topic>Humans</topic><topic>Kidney - blood supply</topic><topic>Kidney - physiology</topic><topic>Kidney Transplantation</topic><topic>Kidneys</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Organ Preservation - methods</topic><topic>Original</topic><topic>Outcome Assessment (Health Care)</topic><topic>Perfusion - methods</topic><topic>Temperature</topic><topic>Transplants & implants</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hosgood, S. A.</creatorcontrib><creatorcontrib>Thompson, E.</creatorcontrib><creatorcontrib>Moore, T.</creatorcontrib><creatorcontrib>Wilson, C. H.</creatorcontrib><creatorcontrib>Nicholson, M. L.</creatorcontrib><collection>Wiley Online Library Open Access</collection><collection>Wiley Online Library Free Content</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>British journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hosgood, S. A.</au><au>Thompson, E.</au><au>Moore, T.</au><au>Wilson, C. H.</au><au>Nicholson, M. L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Normothermic machine perfusion for the assessment and transplantation of declined human kidneys from donation after circulatory death donors</atitle><jtitle>British journal of surgery</jtitle><addtitle>Br J Surg</addtitle><date>2018-03</date><risdate>2018</risdate><volume>105</volume><issue>4</issue><spage>388</spage><epage>394</epage><pages>388-394</pages><issn>0007-1323</issn><eissn>1365-2168</eissn><abstract>Background
A significant proportion of donation after circulatory death (DCD) kidneys are declined for transplantation because of concerns over their quality. Ex vivo normothermic machine perfusion (NMP) provides a unique opportunity to assess the quality of a kidney and determine its suitability for transplantation.
Methods
In phase 1 of this study, declined human DCD kidneys underwent NMP assessment for 60 min. Kidneys were graded 1–5 using a quality assessment score (QAS) based on macroscopic perfusion, renal blood flow and urine output during NMP. In phase 2 of the study, declined DCD kidneys were assessed by NMP with an intention to transplant them.
Results
In phase 1, 18 of 42 DCD kidneys were declined owing to poor in situ perfusion. After NMP, 28 kidneys had a QAS of 1–3, and were considered suitable for transplantation. In phase 2, ten of 55 declined DCD kidneys underwent assessment by NMP. Eight kidneys had been declined because of poor in situ flushing in the donor and five of these were transplanted successfully. Four of the five kidneys had initial graft function.
Conclusion
NMP technology can be used to increase the number of DCD kidney transplants by assessing their quality before transplantation.
Increases available kidneys</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>29210064</pmid><doi>10.1002/bjs.10733</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0007-1323 |
| ispartof | British journal of surgery, 2018-03, Vol.105 (4), p.388-394 |
| issn | 0007-1323 1365-2168 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_5887977 |
| source | Oxford Journals Online |
| subjects | Adult Aged Death Donor Selection Female Humans Kidney - blood supply Kidney - physiology Kidney Transplantation Kidneys Male Middle Aged Organ Preservation - methods Original Outcome Assessment (Health Care) Perfusion - methods Temperature Transplants & implants |
| title | Normothermic machine perfusion for the assessment and transplantation of declined human kidneys from donation after circulatory death donors |
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