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Annals of Transplantation Jul 2019BACKGROUND Prolonged cold ischemia is an established risk factor for poor early graft function (EGF). However, warm ischemia incurring during graft implantation has...
BACKGROUND Prolonged cold ischemia is an established risk factor for poor early graft function (EGF). However, warm ischemia incurring during graft implantation has received little attention regarding its possible detrimental effect on EGF. The aim of our study was to examine the impact of recipient warm ischemia time on EGF. MATERIAL AND METHODS The data of 102 consecutive kidney transplants were analyzed to determine the association between duration of graft implantation time (IT) and EGF. Recipient IT groups were (GI) up to 45 min, (GII) 45-60 min, and (GIII) >60 min. EGF was categorized as immediate (IGF), slow (SGF), or delayed graft function (DGF). In recipients with IGF, graft function was further assessed by time needed for reduction in serum creatinine by 50% (SC50) of pre-transplant value, and serum creatinine on day 7 (SCD7). RESULTS Of a total of 102 recipients, 55 (55%) were in GI, 33 (32%) were in GII, and 14 (13%) were in GIII. Factors prolonging IT were recipient body mass index (BMI) (p=0.02) and multiple arteries in donor kidneys (p<0.01). No recipients in GI had DGF or SGF, while 2 in GII had DGF, and 5 patients in GIII had poor EGF. SC50 was significantly longer in GIII and GII versus GI (40.8±42.4 and 32.8±20.4 vs. 22.2±17.2 [p=.02, p≤.01]), respectively. Mean SCD7 was also significantly higher in GIII and GII versus GI. The mean last serum creatinine was comparable among all groups. CONCLUSIONS IT of more than 45 min was a risk factor for poor EGF, but achieved statistical significance only when it exceeded 60 min. Longer IT also significantly slowed the fall in SC50, and led to a higher SCD7. However, poor EGF and suboptimal early SC trends had little long-term effect on serum creatinine.
Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Delayed Graft Function; Female; Graft Rejection; Graft Survival; Humans; Kidney Transplantation; Male; Middle Aged; Retrospective Studies; Transplant Recipients; Treatment Outcome; Warm Ischemia; Young Adult
PubMed: 31332156
DOI: 10.12659/AOT.916012 -
BioMed Research International 2023Donor lung ventilation and inflation during the warm ischemia could attenuate ischemia-reperfusion injury (IRI) after lung transplantation. Hydrogen sulfide (HS), as a...
Comparison of Inflation and Ventilation with Hydrogen Sulfide during the Warm Ischemia Phase on Ischemia-Reperfusion Injury in a Rat Model of Non-Heart-Beating Donor Lung Transplantation.
Donor lung ventilation and inflation during the warm ischemia could attenuate ischemia-reperfusion injury (IRI) after lung transplantation. Hydrogen sulfide (HS), as a kind of protective gas, has demonstrated the antilung IRI effect. This study is aimed at observing the different methods of administering HS in the setting of warm ischemia, ventilation, and inflation on the lung graft from a rat non-heart-beating donor. After 1 h of cardiac arrest, donor lungs in situ were inflated with 80 ppm HS (FS group), ventilated with 80 ppm HS (VS group), or deflated (control group) for 2 h. Then, the lung transplantation was performed after 3 h cold ischemia. The rats without ischemia and reperfusion were in the sham group. Pulmonary surfactant in the bronchoalveolar lavage fluid was measured in donor lung. The inflammatory response, cell apoptosis, and lung graft function were assessed at 3 h after reperfusion. The lung injury was exacerbated in the control group, which was attenuated significantly after the HS treatment. Compared with the FS group, the pulmonary surfactant in the donor was deteriorated, the lung oxygenation function was decreased, and the inflammatory response and cell apoptosis were increased in the graft in the VS group ( < 0.05). In conclusion, HS inflation during the warm ischemia phase improved the function of lung graft via regulating pulmonary surfactant stability and decreased the lung graft IRI via decreasing the inflammatory response and cell apoptosis.
Topics: Rats; Animals; Warm Ischemia; Hydrogen Sulfide; Pulmonary Surfactants; Lung; Lung Transplantation; Reperfusion Injury; Respiration
PubMed: 36778057
DOI: 10.1155/2023/3645304 -
American Journal of Surgery Oct 2020The objective of this study is to quantitatively evaluate the protective effects of resveratrol for using during renal warm ischemia.
BACKGROUND
The objective of this study is to quantitatively evaluate the protective effects of resveratrol for using during renal warm ischemia.
METHODS
Rats were allocated into 4 groups: Sham, Sham Resveratrol, Ischemia, Ischemia Resveratrol. Sham Resveratrol and Ischemia Resveratrol received resveratrol before surgery. Ischemia and Ischemia Resveratrol had renal vessels clamped. Animals were euthanized four weeks after. Serum urea and creatinine were measured. Renal weight and volume, cortex-non-cortex areas ratio, cortical volume, glomerular volumetric density, volume-weighted mean glomerular volume and number of glomeruli per kidney were evaluated.
RESULTS
Serum urea in Ischemia increased by 10.4% compared to Sham and no differences were observed among Ischemia Resveratrol and sham groups. The glomerular volumetric density and number of glomeruli of Ischemia were lower than Sham but Ischemia Resveratrol had no difference compared to sham groups.
CONCLUSIONS
Preoperative administration of resveratrol has renoprotective effects, preventing the glomerular number reduction observed in warm ischemia.
Topics: Animals; Antioxidants; Disease Models, Animal; Kidney Glomerulus; Male; Rats; Rats, Wistar; Reperfusion Injury; Resveratrol; Warm Ischemia
PubMed: 32098652
DOI: 10.1016/j.amjsurg.2020.02.025 -
General Thoracic and Cardiovascular... Jan 2020In lung transplantation (LTx) from donation after cardiac death (DCD), the donor lungs are inevitably exposed to warm ischemic time (WIT) between the cardiac arrest and...
OBJECTIVE
In lung transplantation (LTx) from donation after cardiac death (DCD), the donor lungs are inevitably exposed to warm ischemic time (WIT) between the cardiac arrest and the initiation of cold preservation. We conducted this study to examine the effect of prolonged WIT on lung allograft rejection in a murine model of LTx from DCD.
METHODS
Allogeneic BALB/c → B6 LTx from DCD was performed with a WIT of 15 min (WIT15 group, n = 5) or 60 min (WIT60 group, n = 5). Recipients were immunosuppressed by perioperative costimulatory blockade. The lung allografts were analyzed by histology and flow cytometry on day 7 after the LTx.
RESULTS
Histologically, the rejection grade in the WIT60 group was significantly higher than that in the WIT15 group (3.4 ± 0.4 vs. 2.2 ± 0.2, P = 0.0278). Moreover, the intragraft CD8+ to CD4+ T cell ratio in the WIT60 group was significantly higher than that in the WIT15 group (2.3 ± 0.12 vs. 1.2 ± 0.11, P < 0.0001).
CONCLUSIONS
Prolonged WIT could exacerbate the severity of lung allograft rejection after LTx from DCD. Minimization of the WIT could improve the outcomes after LTx from DCD.
Topics: Animals; Death, Sudden, Cardiac; Female; Graft Survival; Heart Arrest; Lung; Lung Transplantation; Male; Mice; Mice, Inbred BALB C; Tissue Donors; Warm Ischemia
PubMed: 31367969
DOI: 10.1007/s11748-019-01181-9 -
Journal of Endourology Mar 2023To evaluate the differences in baseline chronic kidney disease (CKD) status in correlations between warm ischemic time (WIT) and acute kidney injury (AKI) or...
To evaluate the differences in baseline chronic kidney disease (CKD) status in correlations between warm ischemic time (WIT) and acute kidney injury (AKI) or acute/chronic renal function change after robot-assisted partial nephrectomy (RAPN). This study retrospectively recruited 1290 patients from a multi-institutional RAPN database. The patients were grouped into four preoperative CKD categories: CKD Group 1 (CKDG1), CKD Group 2 (CKDG2), CKD Group 3a (CKDG3a), and CKD Group 3b (CKDG3b). The correlation between WIT and the probability of AKI was assessed according to the baseline CKD grade, together with changes in serum creatinine (sCr) at the postoperative maximum and chronic renal function. AKI was not observed in the CKDG1 group. The probability of AKI at WIT = 30 minutes was 5.6% for CKDG2, 8.5% for CKDG3a, and 11.6% for CKDG3b (all < 0.05). WIT was an independent predictor of AKI occurrence in the multivariate model for these three CKD groups. Significant weak correlations were observed between WIT and sCr change for all four groups, with = 0.22 for CKDG1, = 0.16 for CKDG2, = 0.03 for CKDG3a, and = 0.09 for ≥CKDG3b. For chronic renal function, correlations were significant in CKDG2, CKDG3a, and ≥CKDG3b, yet was considered small in all cases (<0.1). The association between extended WIT and the probability of AKI increased in patients with more severe baseline CKD. The correlation between WIT and renal function was significant, yet clinically modest.
Topics: Humans; Kidney; Warm Ischemia; Robotics; Kidney Neoplasms; Robotic Surgical Procedures; Retrospective Studies; Treatment Outcome; Glomerular Filtration Rate; Nephrectomy; Acute Kidney Injury; Renal Insufficiency, Chronic
PubMed: 36352821
DOI: 10.1089/end.2022.0493 -
The Journal of Urology Jul 2008Partial nephrectomy is being increasingly performed to treat renal cell carcinoma. Because warm ischemia is induced during many open and laparoscopic partial nephrectomy... (Review)
Review
PURPOSE
Partial nephrectomy is being increasingly performed to treat renal cell carcinoma. Because warm ischemia is induced during many open and laparoscopic partial nephrectomy surgeries, its impact on postoperative kidney function has received renewed attention. We assessed the current state of knowledge pertaining to warm ischemic kidney injury and renal functional outcomes.
MATERIALS AND METHODS
A review of the literature from 1947 to 2007 pertaining to warm ischemic kidney injury was performed. Data from relevant animal and clinical studies were assessed and compared.
RESULTS
Animal studies have described the relationship between the duration of warm ischemia and the magnitude of subsequent renal dysfunction. However, direct translation of these data to clinical practice is limited by significant anatomical and physiological differences among species. Current clinical data support a safe warm ischemia time limit of 30 minutes in patients with normal preoperative kidney function. To date no scientifically rigorous clinical study has established a warm ischemia dose-response curve. Additionally, no algorithm exists to predict the risk of acute kidney injury and chronic kidney disease in patients undergoing transient warm ischemia.
CONCLUSIONS
Clinical use of glomerular filtration rate measurement, kidney injury biomarkers and the application of glomerular filtration rate based renal functional diagnostic criteria may allow improved diagnosis, management and reporting of renal functional outcomes. Prospective, controlled clinical studies are much needed to accurately characterize the relationship between warm ischemia and renal dysfunction.
Topics: Animals; Cold Ischemia; Humans; Kidney Diseases; Warm Ischemia
PubMed: 18485395
DOI: 10.1016/j.juro.2008.03.022 -
Artificial Organs Aug 2023Controlled donation after circulatory determination of death (cDCD) seems an effective way to mitigate the critical shortage of available organs for transplant...
Evaluation of functional warm ischemia time during controlled donation after circulatory determination of death using normothermic regional perfusion (ECMO-TT): A prospective multicenter cohort study.
BACKGROUND
Controlled donation after circulatory determination of death (cDCD) seems an effective way to mitigate the critical shortage of available organs for transplant worldwide. As a recently developed procedure for organ retrieval, some questions remain unsolved such as the uncertainty regarding the effect of functional warm ischemia time (FWIT) on organs´ viability.
METHODS
We developed a multicenter prospective cohort study collecting all data from evaluated organs during cDCD from 2017 to 2020. All the procedures related to cDCD were performed with normothermic regional perfusion. The analysis included organ retrieval as endpoint and FWIT as exposure of interest. The effect of FWIT on the likelihood for organ retrieval was evaluated with Relative distribution analysis.
RESULTS
A total amount of 507 organs´ related information was analyzed from 95 organ donors. Median donor age was 62 years, and 63% of donors were male. Stroke was the most common diagnosis before withdrawal of life-sustaining therapy (61%), followed by anoxic encephalopathy (21%). This analysis showed that length of FWIT was inversely associated with organ retrieval rates for liver, kidneys, and pancreas. No statistically significant association was found for lungs.
CONCLUSIONS
Results showed an inverse association between functional warm ischemia time (FWIT) and retrieval rate. We also have postulated optimal FWIT's thresholds for organ retrieval. FWIT for liver retrieval remained between 6 and less than 11 min and in case of kidneys and pancreas, the optimal FWIT for retrieval was 6 to 12 min. These results could be valuable to improve organ utilization and for future analysis.
Topics: Humans; Male; Middle Aged; Female; Warm Ischemia; Prospective Studies; Extracorporeal Membrane Oxygenation; Organ Preservation; Perfusion; Death; Tissue and Organ Procurement; Graft Survival
PubMed: 37042612
DOI: 10.1111/aor.14539 -
European Urology Focus Jul 2018Nephron mass preservation is a key determinant of functional outcomes after partial nephrectomy (PN), while ischemia plays a secondary role. Analyses focused...
BACKGROUND
Nephron mass preservation is a key determinant of functional outcomes after partial nephrectomy (PN), while ischemia plays a secondary role. Analyses focused specifically on recovery of the operated kidney appear to be most informative, yet have only included limited numbers of patients.
OBJECTIVE
To evaluate the relative impact of parenchymal preservation and ischemia on functional recovery after PN using a more robust cohort allowing for more refined perspectives about ischemia.
DESIGN, SETTING, AND PARTICIPANTS
A total of 401 patients managed with PN with necessary studies were analyzed for function and nephron mass preserved specifically within the kidney exposed to ischemia.
INTERVENTION
PN.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
The nephron mass preserved was measured from computed tomography scans <2 mo before and 3-12 mo after PN. Patients with two kidneys were required to have nuclear renal scans within the same timeframes. Recovery from ischemia was defined as the percent function preserved normalized by the percent nephron mass preserved. Pearson correlation was used to evaluate relationships between functional recovery and nephron mass preservation or ischemia time. Multivariable linear regression assessed predictors for recovery from ischemia.
RESULTS AND LIMITATIONS
The median tumor size was 3.5cm and the median RENAL score was 8. Cold and warm ischemia were utilized in 151 and 250 patients, and the median ischemia time was 27 and 21min, respectively. The function preserved was strongly correlated with nephron mass preserved(r=0.63; p<0.001). Median recovery from ischemia was significantly higher for hypothermia (99% vs 92%; p<0.001) and remained consistently strong even with longer duration. Multivariable analysis demonstrated that recovery from ischemia, which normalizes for nephron mass preservation, was significantly associated with ischemia type and duration (both p<0.05). However, each additional 10min of warm ischemia was associated with only a 2.5% decline in recovery from ischemia. Limitations include the retrospective design.
CONCLUSIONS
Our data suggest that functional recovery from clamped PN is most reliable with hypothermia. Longer intervals of warm ischemia are associates with reduced recovery; however, incremental changes are modest and may not be clinically significant in patients with a normal contralateral kidney.
PATIENT SUMMARY
Functional recovery after clamped partial nephrectomy is primarily dependent on preservation of nephron mass. Recovery is most reliable when hypothermia is applied. Longer intervals of warm ischemia are associated with reduced recovery; however, the incremental changes are modest.
Topics: Cold Ischemia; Female; Glomerular Filtration Rate; Humans; Hypothermia, Induced; Ischemia; Kidney; Kidney Neoplasms; Male; Middle Aged; Nephrectomy; Organ Sparing Treatments; Outcome Assessment, Health Care; Recovery of Function; Time Factors; Tomography, X-Ray Computed; Tumor Burden; Warm Ischemia
PubMed: 28753855
DOI: 10.1016/j.euf.2017.02.001 -
Current Opinion in Organ Transplantation Aug 2022This review describes recent developments in the field of liver perfusion techniques. (Review)
Review
PURPOSE OF REVIEW
This review describes recent developments in the field of liver perfusion techniques.
RECENT FINDINGS
Dynamic preservation techniques are increasingly tested due to the urgent need to improve the overall poor donor utilization. With their exposure to warm ischemia, livers from donors after circulatory death (DCD) transmit additional risk for severe complications after transplantation. Although the superiority of dynamic approaches compared to static-cold-storage is widely accepted, the number of good quality studies remains limited. Most risk factors, particularly donor warm ischemia, and accepted thresholds are inconsistently reported, leading to difficulties to assess the impact of new preservation technologies. Normothermic regional perfusion (NRP) leads to good outcomes after DCD liver transplantation, with however short ischemia times. While randomized controlled trials (RCT) with NRP are lacking, results from the first RCTs with ex-situ perfusion were reported. Hypothermic oxygenated perfusion was shown to protect DCD liver recipients from ischemic cholangiopathy. In contrast, endischemic normothermic perfusion seems to not impact on the development of biliary complications, although this evidence is only available from retrospective studies.
SUMMARY
Dynamic perfusion strategies impact posttransplant outcomes and are increasingly commissioned in various countries along with more evidence from RCTs. Transparent reporting of risk and utilization with uniform definitions is required to compare the role of different preservation strategies in DCD livers with prolonged ischemia times.
Topics: Humans; Organ Preservation; Graft Survival; Perfusion; Warm Ischemia; Tissue Donors; Liver; Ischemia
PubMed: 35438271
DOI: 10.1097/MOT.0000000000000963 -
Acta Obstetricia Et Gynecologica... Feb 2013Uterus transplantation (UTx) has been proposed as a method to treat women with absolute uterine factor infertility. The aim of this study was to evaluate the viability...
OBJECTIVE
Uterus transplantation (UTx) has been proposed as a method to treat women with absolute uterine factor infertility. The aim of this study was to evaluate the viability of the transplanted rat uterus after exposure to long warm ischemic times, in order to mimic a time frame likely to occur in a human situation during complicated pelvic vascular anastomosis surgery.
DESIGN
Experimental study.
SETTING
Obstetrics and Gynecology Department.
POPULATION
Female Lewis rats. Methods. Pseudopregnant rats were randomly allocated into two intervention groups, a standardized syngeneic UTx procedure (control; n = 10) and a modified UTx protocol with a four hour extended period of warm ischemia (n = 10).
MAIN OUTCOME MEASURES
Scoring systems of gross morphology and histology at three and six days after transplantation.
RESULTS
Evident signs of necrosis were seen in five of 10 animals in the warm ischemia group compared with only one of 10 in the control group. Overall, uterine grafts from the warm ischemia group obtained poorer gross morphology scores. Histological findings correlated with the surgical findings at inspections three and six days after surgery.
CONCLUSIONS
An extended warm ischemic time has detrimental effects on the survival of the uterus after transplantation.
Topics: Animals; Female; Models, Animal; Rats; Rats, Inbred Lew; Time Factors; Uterus; Warm Ischemia
PubMed: 23061896
DOI: 10.1111/aogs.12027