RESUMO
Donation after circulatory death (DCD) is a potential source of reducing organ demand. In Italy, DCD requires a 20-min no-touch period that prolongs warm ischemia and increases delayed graft function (DGF) risk and graft loss. We report here our preliminary experience of sequential use of normothermic regional perfusion (NRP), as standard procedure, and hypothermic oxygenated perfusion (HOPE), as an experimental technique of organ preservation, in 10 kidney transplants (KT) from five DCD Maastricht III with extensive functional warm ischemia time (fWIT) up to 325 min. During NRP, renal function tests were evaluated to accept organs which were retrieved according to standard fashion with biopsy. While waiting for pathology and cross-match results, organs were preserved with HOPE through pressure- and temperature-controlled arterial pulsatile flow. All grafts with Karpinski score ≤4 were used for conventional single KT with mean cold ischemia time of 584 ± 167 min and mean fWIT of 151 ± 132 min. At the end of HOPE, lactate levels increased significantly in all cases with DGF (P = 0.0095), which were 3/10 (30%). No primary nonfunctions were recorded, and all patients had sCr < 1.5 mg/dl at 6-month post-KT. NRP and HOPE for DCD may overcome fWIT limits safely, and lactate during HOPE predicts DGF.
Assuntos
Preservação de Órgãos/métodos , Oxigênio/química , Perfusão/métodos , Isquemia Quente , Idoso , Algoritmos , Biópsia , Isquemia Fria , Morte , Função Retardada do Enxerto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Temperatura , Fatores de Tempo , Obtenção de Tecidos e Órgãos , Resultado do TratamentoAssuntos
Cateterismo Venoso Central/instrumentação , Cateterismo Periférico/instrumentação , Cateteres de Demora , Cateteres Venosos Centrais , Veia Ilíaca/cirurgia , Falência Renal Crônica/terapia , Diálise Renal , Idoso , Desenho de Equipamento , Humanos , Veia Ilíaca/diagnóstico por imagem , Falência Renal Crônica/diagnóstico , Masculino , Resultado do TratamentoRESUMO
Acute antibody-mediated rejection (AMR) remains an important challenge in the field of kidney transplantation despite the advances in immunosuppressive strategies, and has been recognized as an important cause of allograft dysfunction and graft loss. The treatments of acute AMR are not standardized and poor evidence is currently available on the effectiveness of therapy regimens with combinations of drugs. Standard treatment for acute AMR is based on 3 cornerstones: removal of donor-specific antibodies (DSAs) from the bloodstream, reduction of DSAs synthesis, and inhibition of the interaction between DSAs and human leukocyte antigen antigens on donor's cells. In this paper, we discuss the mechanism of action of the principal drugs currently in use, the main published studies on this topic, and the future insights related to the treatment of acute AMR.
