The use of in-situ normothermic extracorporeal perfusion and leukocyte depletion for resuscitation of human donor kidneys

Abstract

The unexploited potential of donors after cardiac death is an actual issue for all countries where organ transplantation is performed. The crucial point in uncontrolled donation after cardiac death is the warm ischemic time. The primary purpose of our work was to define the limits of warm ischemic time. Another purpose was the development of an in situ kidney preservation protocol. In 8 uncontrolled donors with warm ischemic time from 45 to 91 minutes, a normothermic extracorporeal perfusion device was applied, providing preservation and restoration of the kidney after ischemic damage. Main attention was paid to the elimination of leukocytes as the key damaging factor from modified donor blood circulating in the device. In 6 out of 16 kidney recipients, graft function was recovered immediately and, by the end of the third month, the average creatinine was 117.9±21.9 mmol/L. Treatment of ischemically damaged kidneys by normothermic extracorporeal perfusion, with leukocyte depletion before procurement, seems to be a challenging protocol and demands further study. Implementation of perfusion systems in organ procurement practice could lead to a partial solution in the organ deficit problem.