A new technique called normothermic machine perfusion might help transplant teams assess the quality of a kidney before it is selected for transplantation, according to research published in the British Medical Journal.
Investigators of the study reviewed the value of the process in assessing the health of donated kidneys. In the first phase of the study, donation after circulatory death (DCD) kidneys that had been declined for transplant underwent normothermic machine perfusion (NMP) assessment for 60 minutes. Researchers used a quality assessment score (QAS; graded 1 to 5) based on macroscopic perfusion, renal blood flow and urine output during NMP. In phase 2 of the study, decreased donor kidneys that were determined suitable for transplant were assessed by NMP.
In phase 1, results showed 18 of 42 deceased donor kidneys had been declined because of poor in situ perfusion. After NMP, however, 28 kidneys had a QAS of 1 to 3. This resulted in a decision that the organs were suitable for transplantation.
In the second phase of the study, researchers used NMP to assess 10 of 55 declined kidneys. In situ flushing in the donor was cited as the cause of decline for eight kidneys. Five were successfully transplanted.
“Of five kidneys that would normally be discarded but were found suitable by the technique, four functioned immediately after transplantation,” Sarah A. Hosgood, PhD, of the University of Cambridge in the United Kingdom and lead author of the study, said in a press release.
“NMP allows the successful transplantation of DCD kidneys that had been deemed unsuitable for transplantation and has potential to increase the number of kidney transplants,” the authors concluded in the study. “There is, however, a pressing need to access declined DCD kidneys more quickly in order to increase the rate of assessment by NMP and the transplant rate.”
Hosgood SA, et al. Br J Surg. 2017;doi:10.1002/bjs.10733.