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Slagter JS, Rijkse E, De Wilde RF, Haen R, Lepiesza A, Cappelle ML, Kimenai DHJAN, Minnee RC. The Effect of Recipient Back-Table Duration on Graft Outcome of Deceased Donor Kidneys: A Single-Center Prospective Cohort Study. J Clin Med 2023; 12:jcm12072647. [PMID: 37048729 PMCID: PMC10094751 DOI: 10.3390/jcm12072647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/10/2023] [Accepted: 03/28/2023] [Indexed: 04/05/2023] Open
Abstract
Background: Little is known about the influence of the duration of the kidney back-table preparation period and kidney temperature on graft outcomes after transplantation. The aim of this study is to investigate the back-table duration and its relation to graft outcome and the relation between kidney temperature and graft outcome. Methods: In this prospective cohort study, deceased donor kidney temperature is measured at fixed time points using an infrared thermometer during back-table preparation and transplantation. Additionally, the back-table duration is measured using a timer. Results: Between September 2020 and July 2021, 49 kidneys were prospectively included in this study. Median back-table duration was 33.7 (standard deviation ± 14.1) min and donor kidney temperature increased up to 14.9 °C (±2.8) after 60 min of back-table preparation. Mean implantation time was 24.9 (±7.6) min and kidney temperature increased up to 25.9 °C (±2.4) after 30 min of implantation time. Longer back-table duration was significantly associated with higher rates of delayed graft function (p = 0.037). However, this observation did not sustain at 3 and 6-months post-transplantation. No association was found between kidney temperature and graft outcomes. Conclusion: Longer back-table duration is significantly associated with DGF after deceased donor kidney transplantation. No association was observed between kidney temperature and graft outcomes of deceased donor kidneys.
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Affiliation(s)
- Julia S. Slagter
- Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC Transplant Institute, 3015 CN Rotterdam, The Netherlands
| | - Elsaline Rijkse
- Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC Transplant Institute, 3015 CN Rotterdam, The Netherlands
| | - Roeland F. De Wilde
- Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC Transplant Institute, 3015 CN Rotterdam, The Netherlands
| | - Roel Haen
- Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC Transplant Institute, 3015 CN Rotterdam, The Netherlands
| | - Agnieszka Lepiesza
- Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC Transplant Institute, 3015 CN Rotterdam, The Netherlands
| | - Marie L. Cappelle
- Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC Transplant Institute, 3015 CN Rotterdam, The Netherlands
| | - Diederik H. J. A. N. Kimenai
- Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC Transplant Institute, 3015 CN Rotterdam, The Netherlands
| | - Robert C. Minnee
- Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC Transplant Institute, 3015 CN Rotterdam, The Netherlands
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2
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Techniques to Ameliorate the Impact of Second Warm Ischemic Time on Kidney Transplantation Outcomes. Transplant Proc 2018; 50:3144-3151. [DOI: 10.1016/j.transproceed.2018.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/25/2018] [Accepted: 09/05/2018] [Indexed: 11/21/2022]
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3
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Heylen L, Pirenne J, Samuel U, Tieken I, Naesens M, Sprangers B, Jochmans I. The Impact of Anastomosis Time During Kidney Transplantation on Graft Loss: A Eurotransplant Cohort Study. Am J Transplant 2017; 17:724-732. [PMID: 27593738 DOI: 10.1111/ajt.14031] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 08/01/2016] [Accepted: 08/22/2016] [Indexed: 01/25/2023]
Abstract
Recent studies raised the concern that warm ischemia during completion of vascular anastomoses in kidney implantation harms the transplant, but its precise impact on outcome and its interaction with other risk factors remain to be established. We investigated the relationship between anastomosis time and graft survival at 5 years after transplantation in 13 964 recipients of deceased donor solitary kidney transplants in the Eurotransplant region. Anastomosis time was independently associated with graft loss after adjusting for other risk factors (adjusted hazard ratio [HR] 1.10 for every 10-min increase, 95% confidence interval [CI] 1.06-1.14; p < 0.0001), whereas it did not influence recipient survival (HR 1.00, 95% CI 0.97-1.02). Kidneys from donation after circulatory death (DCD) were less tolerant of prolonged anastomosis time than kidneys from donation after brain death (p = 0.02 for interaction). The additive effect of anastomosis time with donor warm ischemia time (WIT) explains this observation because DCD status was no longer associated with graft survival when adjusted for this summed WIT, and there was no interaction between DCD status and summed WIT. Time to create the vascular anastomoses in kidney transplantation is associated with inferior transplant outcome, especially in recipients of DCD kidneys.
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Affiliation(s)
- L Heylen
- Department of Nephrology and Kidney Transplantation, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Nephrology, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - J Pirenne
- Department of Abdominal Transplantation Surgery, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Abdominal Transplant Surgery, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - U Samuel
- Eurotransplant International Foundation, Leiden, the Netherlands
| | - I Tieken
- Eurotransplant International Foundation, Leiden, the Netherlands
| | - M Naesens
- Department of Nephrology and Kidney Transplantation, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Nephrology, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - B Sprangers
- Department of Nephrology and Kidney Transplantation, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Nephrology, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - I Jochmans
- Department of Abdominal Transplantation Surgery, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Abdominal Transplant Surgery, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
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Kamińska D, Kościelska-Kasprzak K, Chudoba P, Hałoń A, Mazanowska O, Gomółkiewicz A, Dzięgiel P, Drulis-Fajdasz D, Myszka M, Lepiesza A, Polak W, Boratyńska M, Klinger M. The influence of warm ischemia elimination on kidney injury during transplantation - clinical and molecular study. Sci Rep 2016; 6:36118. [PMID: 27808277 PMCID: PMC5093711 DOI: 10.1038/srep36118] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 10/11/2016] [Indexed: 11/21/2022] Open
Abstract
Kidney surface cooling was used during implantation to assess the effect of warm ischemia elimination on allograft function, histological changes and immune-related gene expression. 23 recipients were randomly assigned to a group operated on with kidney surface cooling during implantation (ice bag technique, IBT group), and the other 23 recipients receiving the contralateral kidney from the same donor were operated on with a standard technique. Three consecutive kidney core biopsies were obtained during the transplantation procedure: after organ recovery, after cold ischemia and after reperfusion. Gene expression levels were determined using low-density arrays (Format 32, TaqMan). The IBT group showed a significantly lower rate of detrimental events (delayed graft function and/or acute rejection, p = 0.015) as well as higher glomerular filtration rate on day 14 (p = 0.026). A greater decrease of MMP9 and LCN2 gene expression was seen in the IBT group during total ischemia (p = 0.003 and p = 0.018). Elimination of second warm ischemia reduced the number of detrimental events after kidney transplantation, and thus had influence on the short-term but not long-term allograft function. Surface cooling of the kidney during vascular anastomosis may reduce some detrimental effects of immune activation resulting from both brain death and ischemia-reperfusion injury.
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Affiliation(s)
- Dorota Kamińska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław 50-556, Poland
| | | | - Paweł Chudoba
- Department of General, Vascular and Transplant Surgery, Wroclaw Medical University, Wrocław 50-556, Poland
| | - Agnieszka Hałoń
- Department of Pathomorphology and Oncological Cytology, Wroclaw Medical University, Wrocław 50-556, Poland
| | - Oktawia Mazanowska
- Faculty of Medicine and Dentistry, Wroclaw Medical University, Wrocław 50-556, Poland
| | - Agnieszka Gomółkiewicz
- Department of Histology and Embryology, Wroclaw Medical University, 50-368, Wrocław, Poland
| | - Piotr Dzięgiel
- Department of Histology and Embryology, Wroclaw Medical University, 50-368, Wrocław, Poland
| | - Dominika Drulis-Fajdasz
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław 50-556, Poland
| | - Marta Myszka
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław 50-556, Poland
| | - Agnieszka Lepiesza
- Department of General, Vascular and Transplant Surgery, Wroclaw Medical University, Wrocław 50-556, Poland
| | - Wojciech Polak
- Department of Surgery, Division of HPB and Transplantation Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Maria Boratyńska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław 50-556, Poland
| | - Marian Klinger
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław 50-556, Poland
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5
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Lázaro A, Humanes B, Jado JC, Mojena M, González-Nicolás MÁ, del Cañizo JF, Tejedor A, Lledó-García E. Beneficial Effect of Short Pretransplant Period of Hypothermic Pulsatile Perfusion of the Warm-Ischemic Kidney after Cold Storage: Experimental Study. BIOMED RESEARCH INTERNATIONAL 2016; 2016:2518626. [PMID: 27556029 PMCID: PMC4983324 DOI: 10.1155/2016/2518626] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 06/10/2016] [Accepted: 07/10/2016] [Indexed: 11/30/2022]
Abstract
Warm ischemia (WI) produces a significant deleterious effect in potential kidney grafts. Hypothermic machine perfusion (HMP) seems to improve immediate graft function after transplant. Our aim was to analyze the effect of short pretransplant periods of pulsatile HMP on histology and renal injury in warm-ischemic kidneys. Twelve minipigs were used. WI was achieved in the right kidney by applying a vascular clamp for 45 min. After nephrectomy, autotransplant was performed following one of two strategies: cold storage of the kidneys or cold storage combined with perfusion in pulsatile HMP. The graft was removed early to study renal morphology, inflammation (fibrosis), and apoptosis. Proinflammatory activity and fibrosis were less pronounced after cold storage of the kidneys with HMP than after cold storage only. The use of HMP also decreased apoptosis compared with cold storage only. The detrimental effects on cells of an initial and prolonged period of WI seem to improve with a preservation protocol that includes a short period of pulsatile HMP after cold storage and immediately before the transplant, in comparison with cold storage only.
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Affiliation(s)
- Alberto Lázaro
- Renal Physiopathology Laboratory, Department of Nephrology, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - Blanca Humanes
- Renal Physiopathology Laboratory, Department of Nephrology, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - Juan Carlos Jado
- Renal Physiopathology Laboratory, Department of Nephrology, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - Marina Mojena
- Renal Physiopathology Laboratory, Department of Nephrology, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - María Ángeles González-Nicolás
- Renal Physiopathology Laboratory, Department of Nephrology, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - Juan Francisco del Cañizo
- Medicine and Surgery Unit, IiSGM, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
- Department of Surgery, Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
| | - Alberto Tejedor
- Renal Physiopathology Laboratory, Department of Nephrology, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
- Department of Medicine, Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
| | - Enrique Lledó-García
- Urology Department, IiSGM, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
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6
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Tennankore KK, Kim SJ, Alwayn I, Kiberd BA. The Authors Reply. Kidney Int 2016; 90:227. [PMID: 27312454 DOI: 10.1016/j.kint.2016.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 03/24/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Karthik K Tennankore
- Department of Medicine, Division of Nephrology, Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.
| | - S Joseph Kim
- Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Ian Alwayn
- Department of Surgery, Multi-Organ Transplant Program, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Bryce A Kiberd
- Department of Medicine, Division of Nephrology, Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
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