Using pulsatile perfusion to successfully transplant kidneys with 15 percent glomerulosclerosis
Marty Sellers1,2, Lee Langley2, Paula Lawrence3, David Marshman3, Dustin Diggs2, Jean Davis3.
1Emory University, Atlanta, GA, United States; 2LifeLink of Georgia, Norcross, GA, United States; 3LifeLink Foundation, Tampa, FL, United States
Purpose: Transplantable kidneys are too often discarded, partially due to the inefficiency of our allocation system, and partially due to uncertainty of their quality, especially if a biopsy shows ≥15% glomerulosclerosis (GS). Pulsatile perfusion (PP) of kidneys allows a semi-physiologic evaluation of their quality; it also results in decreased delayed graft function (DGF) of those eventually transplanted. We developed a strategy of PP for all ≥51%-KDPI kidneys in 2018 to see if showing favorable pump metrics (flow, resistance) would lead to fewer kidneys discarded.
Methods: PP was planned for 1 year in all ≥51%-KDPI kidneys, beginning June 1, 2018. If an accepting center requested, kidneys were not preserved with PP. We compared our acceptance for the 12 months post-implementation with our experience 2 years pre-implementation. Recipient 6- and 12-month (if follow-up allowed) creatinines were also recorded.
Results: 568 kidneys were recovered for transplant and 243 preserved with PP, 59 (10.4%) of these also had KDPI ≥51% and GS ≥15% (range 15-30%). 31 (52.5%) of these were preserved with PP; the other 28 were discarded. 9 (29%) of the 31 PP kidneys were transplanted into 8 recipients. The average recipient 6-month creatinine was 1.7 (range 0.89-3.71); 6 recipients have at least 12-months follow-up with a mean creatinine = 1.76 (range 0.89-4.4); 5 of these had a creatinine less than 1.6. DGF was reported in 2 (25%) of the recipients. In the 2 years pre-PP, we only had 2 of 44 kidneys with 51% KDPI/15% GS transplanted (p=0.0005) without PP; 8 others were exported and transplanted after PP at the accepting center.
Conclusion: PP enhances the ability of OPOs to place kidneys from donors with biopsies showing ≥15% GS. Moreover, these kidneys work well for the majority of recipients. Further studies are needed to refine the PP parameters to predict which kidneys will provide long term dialysis independence.
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