Machine perfusion viability testing

T.C. van Smaalen, E.R. Hoogland, L.W. van Heurn

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

PURPOSE OF REVIEW: Pretransplant assessment of kidney graft viability may help clinicians to decide whether to accept or discard a kidney for transplantation. With the increasing demand for donor kidneys and the increased use of marginal kidneys, the need of viability markers has increased to pursue superior transplant outcomes. Hypothermic machine perfusion (HMP) provides the theoretical opportunity to assess the viability of donor kidneys. We discuss the novel developments in viability testing during HMP and address the future prospects. RECENT FINDINGS: HMP viability testing has focused on the analysis of machine perfusion parameters and perfusate biomarkers. Renal resistance and the biomarkers lactate dehydrogenase, aspartate transaminase, glutathione-S-transferase, N-acetyl-beta-D-glucosaminidase, heart-type fatty acid binding protein, lipid peroxidation products, redox-active iron and IL-18 are correlated with transplant outcome in terms of development of delayed graft function or graft survival. However, they all lack adequate predictive value for transplant outcome. New techniques including contrast-enhanced ultrasound, three-dimensional ultrasound and magnetic resonance spectrometry are promising methods to test kidney viability during HMP, but their value has to be established. The introduction of normothermic machine perfusion offers other promising opportunities for viability testing. SUMMARY: Machine perfusion characteristics and perfusate biomarkers have been extensively studied. They often correlate with the transplant outcome, but the present viability tests are not reliable predictors of transplant outcome. New developments in kidney graft viability assessment are necessary to have a chance of being clinically useful in the future.
Original languageEnglish
Pages (from-to)168-173
Number of pages6
JournalCurrent Opinion in Organ Transplantation
Volume18
Issue number2
DOIs
Publication statusPublished - Apr 2013

Keywords

  • biomarkers
  • kidney transplantation
  • machine perfusion
  • viability testing
  • DELAYED GRAFT FUNCTION
  • MAGNETIC-RESONANCE-SPECTROSCOPY
  • COLD-STORAGE
  • DONOR KIDNEYS
  • PIG-KIDNEY
  • PRESERVATION
  • TRANSPLANTATION
  • BIOMARKERS
  • INJURY
  • RESISTANCE

Cite this

van Smaalen, T. C., Hoogland, E. R., & van Heurn, L. W. (2013). Machine perfusion viability testing. Current Opinion in Organ Transplantation, 18(2), 168-173. https://doi.org/10.1097/MOT.0b013e32835e2a1b