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• W2039970991 abstract "No AccessJournal of UrologyAdult Urology1 Jun 2013Renal Perfusion Pump Vs Cold Storage for Donation After Cardiac Death Kidneys: A Systematic Review Varunkumar Bathini, Thomas McGregor, Vivian C. McAlister, Patrick P.W. Luke, and Alp Sener Varunkumar BathiniVarunkumar Bathini Department of Surgery, University of Western Ontario and Multi-Organ Transplant Program, Ontario, Canada University Hospital, London Health Sciences Centre, London, Ontario, Canada More articles by this author , Thomas McGregorThomas McGregor Department of Surgery, University of Western Ontario and Multi-Organ Transplant Program, Ontario, Canada University Hospital, London Health Sciences Centre, London, Ontario, Canada More articles by this author , Vivian C. McAlisterVivian C. McAlister Department of Surgery, University of Western Ontario and Multi-Organ Transplant Program, Ontario, Canada University of Western Ontario and Multi-Organ Transplant Program, Ontario, Canada University Hospital, London Health Sciences Centre, London, Ontario, Canada More articles by this author , Patrick P.W. LukePatrick P.W. Luke Department of Surgery, University of Western Ontario and Multi-Organ Transplant Program, Ontario, Canada University of Western Ontario and Multi-Organ Transplant Program, Ontario, Canada Matthew Mailing Center for Translational Transplant Studies, Ontario, Canada University Hospital, London Health Sciences Centre, London, Ontario, Canada More articles by this author , and Alp SenerAlp Sener Department of Surgery, University of Western Ontario and Multi-Organ Transplant Program, Ontario, Canada Department of Microbiology and Immunology, University of Western Ontario and Multi-Organ Transplant Program, Ontario, Canada University of Western Ontario and Multi-Organ Transplant Program, Ontario, Canada Matthew Mailing Center for Translational Transplant Studies, Ontario, Canada University Hospital, London Health Sciences Centre, London, Ontario, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.11.173AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Static cold storage is generally used to preserve kidney allografts from deceased donors. Hypothermic machine perfusion may improve the outcome after transplantation but few studies with limited power have addressed this issue. We reviewed evidence of the effectiveness of storing kidneys from deceased donors after cardiac death before transplantation using cold static storage solution or pulsatile hypothermic machine perfusion. Materials and Methods: We searched electronic databases in September 2011 for systematic reviews and/or meta-analyses, randomized, controlled trials and studies of other designs that compared delayed graft function and graft survival. Sources included The Cochrane Library, PubMed® and EMBASE®. Studies excluded from review included those that did not discriminate between donation after cardiac death and donation from a neurologically deceased donor. Primary outcomes were delayed graft function and 1-year graft survival. Statistical analysis was done using RevMan (http://ims.cochrane.org/revman). Results: Nine studies qualified for review. Pulsatile perfusion pumped kidneys from donation after cardiac death donors had decreased delayed graft function compared to kidneys placed in cold storage (OR 0.64, 95% CI 0.43–0.95, p = 0.03). There was a trend toward improved 1-year graft survival in the pulsatile perfusion group but statistical significance was not attained (OR 0.74, 95% CI 0.48–1.13, p = 0.17). Conclusions: Pulsatile machine perfusion of donation after cardiac death kidneys appears to decrease the delayed graft function rate. We noted no benefit in 1-year graft survival. Due to the great heterogeneity among the trials as well as several confounding factors, the overall impact on allograft function and survival requires more study. References 1 : Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med1999; 341: 1725. Google Scholar 2 : Increased kidney transplantation utilizing expanded criteria deceased organ donors with results comparable to standard criteria donor transplant. Ann Surg2004; 239: 688. Google Scholar 3 : Long-term renal outcomes after delayed graft function. Adv Chronic Kidney Dis2008; 15: 248. Google Scholar 4 : Delayed graft function in kidney transplantation. Lancet2004; 364: 1814. Google Scholar 5 : Machine perfusion or cold storage in deceased-donor kidney transplantation. N Engl J Med2009; 360: 7. Google Scholar 6 : Hydrogen sulphide improves real-time renal microvascular flow and attenuates renal injury following prolonged warm ischemia reperfusion injury. Can Urol Assoc J2011; 5: S165. Google Scholar 7 : Machine perfusion versus cold storage for the preservation of kidneys donated after cardiac death: a multicenter, randomized, controlled trial. Ann Surg2010; 252: 756. Google Scholar 8 : Cold machine perfusion versus static cold storage of kidneys donated after cardiac death: a UK multicenter randomized controlled trial. Am J Transplant2010; 10: 1991. Google Scholar 9 : Outcomes of kidneys from donors after cardiac death: Implications for allocation and preservation. Am J Transplant2007; 7: 1797. Google Scholar 10 : Preservation of cadaveric renal allografts-comparison of flushing and pumping techniques. Proc Eur Dial Transplant Assoc1977; 14: 302. Google Scholar 11 : The effect of machine perfusion preservation versus cold storage on the function of kidneys from non-heart-beating donors. Transplantation1994; 57: 293. Google Scholar 12 : The influence of pulsatile preservation in kidney transplantation from non-heart-beating donors. Transplant Proc2007; 39: 1323. Google Scholar 13 : Impact of pulsatile perfusion on postoperative outcome of kidneys from controlled donors after cardiac death. Transplant Int2008; 21: 899. Google Scholar 14 : A controlled clinical trial of machine perfusion of cadaveric donor renal allografts. Lancet1975; 2: 287. Google Scholar 15 : Preservation of non-heart-beating donor kidneys: a clinical prospective randomised case-control study of machine perfusion versus cold storage. Transplant Proc2001; 33: 847. Google Scholar 16 : Perfusion of renal allografts with verapamil improves graft function. Transplantation2008; 86: 1463. Google Scholar 17 : The effects of molecules CORM-3 and H2S on renal protection during pulsatile perfusion. Am J Transplant2011; 2: A1614. Google Scholar 18 : Supplemental hydrogen sulphide protects transplant kidney function and prolongs recipient survival after prolonged cold ischaemia-reperfusion injury by mitigating renal graft apoptosis and inflammation. BJU Int2012; 110: E1187. Google Scholar 19 : Detrimental effects of prolonged warm renal ischaemia-reperfusion injury are abrogated by supplemental hydrogen sulphide: an analysis using real-time intravital microscopy and polymerase chain reaction. BJU Int2012; 110: E1218. Google Scholar 20 : Donor kidney disease and transplant outcome for kidneys donated after cardiac death. Br J Surg2009; 96: 299. Google Scholar © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 6June 2013Page: 2214-2220Supplementary Materials Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.Keywordspulsatile flowkidney transplantioncold ischemiadelayed graft functionkidneyMetricsAuthor Information Varunkumar Bathini Department of Surgery, University of Western Ontario and Multi-Organ Transplant Program, Ontario, Canada University Hospital, London Health Sciences Centre, London, Ontario, Canada More articles by this author Thomas McGregor Department of Surgery, University of Western Ontario and Multi-Organ Transplant Program, Ontario, Canada University Hospital, London Health Sciences Centre, London, Ontario, Canada More articles by this author Vivian C. McAlister Department of Surgery, University of Western Ontario and Multi-Organ Transplant Program, Ontario, Canada University of Western Ontario and Multi-Organ Transplant Program, Ontario, Canada University Hospital, London Health Sciences Centre, London, Ontario, Canada More articles by this author Patrick P.W. Luke Department of Surgery, University of Western Ontario and Multi-Organ Transplant Program, Ontario, Canada University of Western Ontario and Multi-Organ Transplant Program, Ontario, Canada Matthew Mailing Center for Translational Transplant Studies, Ontario, Canada University Hospital, London Health Sciences Centre, London, Ontario, Canada More articles by this author Alp Sener Department of Surgery, University of Western Ontario and Multi-Organ Transplant Program, Ontario, Canada Department of Microbiology and Immunology, University of Western Ontario and Multi-Organ Transplant Program, Ontario, Canada University of Western Ontario and Multi-Organ Transplant Program, Ontario, Canada Matthew Mailing Center for Translational Transplant Studies, Ontario, Canada University Hospital, London Health Sciences Centre, London, Ontario, Canada More articles by this author Expand All Advertisement PDF DownloadLoading ..." @default.
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