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Peritoneal cooling may provide improved protection for uncontrolled donors after cardiac death

Lookup NU author(s): Susan Stamp, David Talbot

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Abstract

Uncontrolled donation after cardiac death (DCD) renal transplantation relies on rapid establishment of organ preservation interventions. We have developed a model of the uncontrolled DCD, comparing current in situ perfusion (ISP) techniques with additional peritoneal cooling (PC). Ten pigs were killed and subjected to a 2 h ischemia period. The ISP group modeled current DCD protocols. The PC group (PC) modeled current protocols plus PC. Two animals were used as controls and subjected to 2 h of warm ischemia. Core renal temperature and microdialysis markers of ischemia were measured. Preservation interventions began at 30 min, with rapid laparotomy and kidney recovery performed at 2 h, prior to machine perfusion viability testing. The final mean renal temperature achieved in the ISP group was 26.3°C versus 16.9°C in the PC group (p = 0.0001). A significant cryopreservation benefit was suggested by lower peak microdialysate lactate and glycerol levels (ISP vs. PC, p = 0.0003 and 0.0008), and the superiority of the PC group viability criteria (p = 0.0147). This pilot study has demonstrated significant temperature, ischemia protection and viability assessment benefits with the use of supplementary PC. The data suggests a need for further research to determine the potential for reductions in the rates of ischemia-related clinical phenomena for uncontrolled DCDs. © 2009 The American Society of Transplantation and the American Society of Transplant Surgeons.


Publication metadata

Author(s): Navarro A, Asher J, Sohrabi S, Reddy M, Stamp S, Carter N, Talbot D

Publication type: Article

Publication status: Published

Journal: American Journal of Transplantation

Year: 2009

Volume: 9

Issue: 6

Pages: 1317-1323

ISSN (print): 1600-6135

ISSN (electronic): 1600-6143

Publisher: Wiley-Blackwell

URL: http://dx.doi.org/10.1111/j.1600-6143.2009.02633.x

DOI: 10.1111/j.1600-6143.2009.02633.x


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