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Re: Renal Transplantation after Ex Vivo Normothermic Perfusion: The First Clinical Study
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RENAL TRANSPLANTATION AND RENOVASCULAR HYPERTENSION
Transplantation/Vascular Surgery Urological Survey Renal Transplantation and Renovascular Hypertension Re: Quantification of the Early Risk of Death in Elderly Kidney Transplant Recipients J. S. Gill, E. Schaeffner, S. Chadban, J. Dong, C. Rose, O. Johnston and J. Gill Division of Nephrology, University of British Columbia, Vancouver, Canada, and Tufts-New England Medical Center, Boston, Massachusetts Am J Transplant 2013; 13: 427e432.
Abstract available at http://jurology.com/ Editorial Comment: This is an interesting analysis that addresses the survival advantage of patients undergoing transplantation compared to wait-listed patients. The authors stratify cases based on cardiovascular comorbidity and rate them as low, intermediate or high. Living donor transplantation gave an immediate survival advantage for low and intermediate risk candidates. The longest time to equal survival was in high risk candidates receiving an expanded criteria donor kidney, and was 521 days. That means that living donation rapidly gives an immediate survival advantage in many candidates and that the break-even point for the highest risk combination was less than 1.5 years. This is good news for appropriately selected older candidates and should encourage the use of living donors in this population. David A. Goldfarb, M.D.
Re: Renal Transplantation after Ex Vivo Normothermic Perfusion: The First Clinical Study S. A. Hosgood Department of Infection, Immunity and Inflammation, Transplant Group, Leicester General Hospital, University of Leicester, Leicester, United Kingdom Am J Transplant 2013; 13: 1246e1252.
Abstract available at http://jurology.com/ Editorial Comment: Hypothermic pulsatile perfusion has become an important method for preservation of nonstandard criteria donor kidneys. This method has beneficial effects in assessing kidneys for use and is associated with decreased rates of delayed graft function. Nonetheless, injury still develops in hypothermically stored organs at reperfusion. Preliminary animal experiments suggest that a brief period of exposure to normothermic oxygenated perfusion ex vivo just before transplantation may afford organ rehabilitation and lead to improved early function. Importantly interventions to improve kidney function can be delivered at metabolic temperatures that are not achievable at low temperatures. The authors showed a marked reduction in delayed graft function compared to standard cold storage. The apparatus was simple to construct and used a red blood cell based perfusate. If such experience can be replicated, normothermic oxygenated perfusion could become an important technique for organ rehabilitation and storage for deceased donor programs. David A. Goldfarb, M.D.
RENAL TRANSPLANTATION AND RENOVASCULAR HYPERTENSION
Transplantation/Vascular Surgery Urological Survey Renal Transplantation and Renovascular Hypertension Re: Quantification of the Early Risk of Death in Elderly Kidney Transplant Recipients J. S. Gill, E. Schaeffner, S. Chadban, J. Dong, C. Rose, O. Johnston and J. Gill Division of Nephrology, University of British Columbia, Vancouver, Canada, and Tufts-New England Medical Center, Boston, Massachusetts Am J Transplant 2013; 13: 427e432.
Abstract available at http://jurology.com/ Editorial Comment: This is an interesting analysis that addresses the survival advantage of patients undergoing transplantation compared to wait-listed patients. The authors stratify cases based on cardiovascular comorbidity and rate them as low, intermediate or high. Living donor transplantation gave an immediate survival advantage for low and intermediate risk candidates. The longest time to equal survival was in high risk candidates receiving an expanded criteria donor kidney, and was 521 days. That means that living donation rapidly gives an immediate survival advantage in many candidates and that the break-even point for the highest risk combination was less than 1.5 years. This is good news for appropriately selected older candidates and should encourage the use of living donors in this population. David A. Goldfarb, M.D.
Re: Renal Transplantation after Ex Vivo Normothermic Perfusion: The First Clinical Study S. A. Hosgood Department of Infection, Immunity and Inflammation, Transplant Group, Leicester General Hospital, University of Leicester, Leicester, United Kingdom Am J Transplant 2013; 13: 1246e1252.
Abstract available at http://jurology.com/ Editorial Comment: Hypothermic pulsatile perfusion has become an important method for preservation of nonstandard criteria donor kidneys. This method has beneficial effects in assessing kidneys for use and is associated with decreased rates of delayed graft function. Nonetheless, injury still develops in hypothermically stored organs at reperfusion. Preliminary animal experiments suggest that a brief period of exposure to normothermic oxygenated perfusion ex vivo just before transplantation may afford organ rehabilitation and lead to improved early function. Importantly interventions to improve kidney function can be delivered at metabolic temperatures that are not achievable at low temperatures. The authors showed a marked reduction in delayed graft function compared to standard cold storage. The apparatus was simple to construct and used a red blood cell based perfusate. If such experience can be replicated, normothermic oxygenated perfusion could become an important technique for organ rehabilitation and storage for deceased donor programs. David A. Goldfarb, M.D.