Perfusate composition and duration of ex-vivo normothermic perfusion in kidney transplantation: a systematic review

Fard, A., Pearson, R., Lathan, R. , Mark, P. B. and Clancy, M. J. (2022) Perfusate composition and duration of ex-vivo normothermic perfusion in kidney transplantation: a systematic review. Transplant International, 35, 10236. (doi: 10.3389/ti.2022.10236) (PMID:35634582) (PMCID:PMC9130468)

Abstract

Ex-vivo normothermic perfusion (EVNP) is an emerging strategy in kidney preservation that enables resuscitation and viability assessment under pseudo-physiological conditions prior to transplantation. The optimal perfusate composition and duration, however, remain undefined. A systematic literature search (Embase; Medline; Scopus; and BIOSIS Previews) was conducted. We identified 1,811 unique articles dating from January 1956 to July 2021, from which 24 studies were deemed eligible for qualitative analysis. The perfusate commonly used in clinical practice consisted of leukocyte-depleted, packed red blood cells suspended in Ringer’s lactate solution with Mannitol, dexamethasone, heparin, sodium bicarbonate and a specific nutrient solution supplemented with insulin, glucose, multivitamins and vasodilators. There is increasing support in preclinical studies for non-blood cell-based perfusates, including Steen solution, synthetic haem-based oxygen carriers and acellular perfusates with supraphysiological carbogen mixtures that support adequate oxygenation whilst also enabling gradual rewarming. Extended durations of perfusion (up to 24 h) were also feasible in animal models. Direct comparison between studies was not possible due to study heterogeneity. Current evidence demonstrates safety with the aforementioned widely used protocol, however, extracellular base solutions with adequate oxygenation, supplemented with nutrient and metabolic substrates, show promise by providing a suitable environment for prolonged preservation and resuscitation. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021231381, identifier PROSPERO 2021 CRD42021231381

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Pearson, Robert and Mark, Professor Patrick and Clancy, Mr Marc and Lathan, Dr Rashida
• Authors: Fard, A., Pearson, R., Lathan, R., Mark, P. B., and Clancy, M. J.
• College/School: College of Medical Veterinary and Life Sciences; College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Transplant International
• Publisher: Frontiers Media
• ISSN: 0934-0874
• ISSN (Online): 1432-2277
• Copyright Holders: Copyright © 2022 The Authors
• First Published: First published in Transplant International 35:10236
• Publisher Policy: Reproduced under a Creative Commons License