{"id":3110,"date":"2023-05-31T10:36:31","date_gmt":"2023-05-31T02:36:31","guid":{"rendered":"https:\/\/transnovo.com\/news\/lifeport%e4%b8%b4%e5%ba%8a%e6%a1%88%e4%be%8b%e5%88%86%e4%ba%ab%ef%bc%88%e4%ba%8c%ef%bc%89%ef%bc%9a%e7%81%8c%e6%b3%a8%e5%8f%82%e6%95%b0%e5%8a%a9%e5%8a%9b%e4%b8%b4%e5%ba%8a%e8%af%84%e4%bc%b0%e4%be%9b\/"},"modified":"2023-05-31T10:36:31","modified_gmt":"2023-05-31T02:36:31","slug":"lifeport%e4%b8%b4%e5%ba%8a%e6%a1%88%e4%be%8b%e5%88%86%e4%ba%ab%ef%bc%88%e4%ba%8c%ef%bc%89%ef%bc%9a%e7%81%8c%e6%b3%a8%e5%8f%82%e6%95%b0%e5%8a%a9%e5%8a%9b%e4%b8%b4%e5%ba%8a%e8%af%84%e4%bc%b0%e4%be%9b","status":"publish","type":"post","link":"https:\/\/transnovo.com\/en\/news\/lifeport%e4%b8%b4%e5%ba%8a%e6%a1%88%e4%be%8b%e5%88%86%e4%ba%ab%ef%bc%88%e4%ba%8c%ef%bc%89%ef%bc%9a%e7%81%8c%e6%b3%a8%e5%8f%82%e6%95%b0%e5%8a%a9%e5%8a%9b%e4%b8%b4%e5%ba%8a%e8%af%84%e4%bc%b0%e4%be%9b\/","title":{"rendered":"LifePort Clinical Case Sharing (II): Perfusion Parameters Help Clinical Assessment of Donor Kidney Quality"},"content":{"rendered":"
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Preface<\/strong><\/p>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n

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LifePort Renal Perfusion Run Chamber<\/span><\/strong>The perfusion parameters can assess the preoperative quality of the donor kidney, and compared with puncture biopsy, the parameter judgment is simple and easy, belongs to the non-invasive operation, and has a very high clinical use value.The 2019 edition of the \"cadaveric donor kidney extracorporeal mechanical perfusion cold preservation technology operation specification\" clearly gives the recommendations for the clinical use of the donor kidney under the different perfusion time, flow rate, and resistance index, and at the same time, emphasizes that in the application of the assessment of the parameters of the LifePort, the It also emphasizes that when using LifePort parameters for evaluation, it is necessary to combine the clinical characteristics of the donor, the process of organ procurement and the pathology of the donor kidney as a common basis for kidney evaluation.<\/p>\n


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A total of three clinical cases are presented in this article, which exemplify the role of LifePort perfusion parameters in the evaluation of donor kidneys by comprehensively analyzing donor clinical information, perfusion parameters, pathological findings, and recipient prognosis.<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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Case 1<\/strong><\/p>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n

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Donor status<\/strong><\/span>: Female, 68 years old, diagnosis: cerebral hemorrhage. Previous history of hypertension for 2 years, diabetes mellitus for 10 years. Admission: serum creatinine 85\u03bcmol\/L, urine routine: protein +\/-.<\/span>
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Perfusion of donor kidneys<\/span><\/strong>: The left kidney was perfused for 7 hours using LifePort. Perfusion temperature was 4-6\u00b0C, perfusion pressure 35 mmHg, initial resistance index >1.0, initial flow rate 28 ml\/min; at the end of perfusion resistance index 0.80, flow rate 40 ml\/min.<\/span><\/p>\n


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Specific perfusion parameters of the left kidney<\/span><\/p>\n

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The right kidney was perfused for 13 hours using LifePort. The perfusion temperature was 4-6\u00b0C, the perfusion pressure was 40 mmHg, the initial resistance index was 0.90, and the initial flow rate was 50 ml\/min; after 13 hours of perfusion, the resistance index was 0.60 and the flow rate was 60 ml\/min.<\/span><\/p>\n


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Specific perfusion parameters of the right kidney<\/p>\n<\/section>\n

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Donor kidney outcome<\/span><\/strong>: LifePort perfusion parameters suggested suboptimal flow and resistance indices in both kidneys, renal pathology was punctured in the same walk, and the pathologic diagnosis was: diabetic nephropathy stage IIb with diffuse glomerular damage. The combination of LifePort parameters and pathologic findings led to the final decision to abandon both kidneys.<\/p>\n


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Pathologic findings in both kidneys<\/span><\/p>\n


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Case summary<\/span><\/strong>: The donor kidneys in this case were ECD donor kidneys and the donor had a long history of diabetes mellitus. LifePort was applied for perfusion, and the initial perfusion flow of both kidneys was 28 ml\/min and 50 ml\/min, respectively, with an initial resistance index of \u22650.9. After a long period of perfusion, there was no significant improvement in the perfusion parameters of both kidneys. The simultaneous pathologic results suggested a glomerulosclerosis rate of 30%-50%, and the final decision was made to discard the bilateral donor kidneys. In this case.LifePort perfusion parameters corroborate with pathologic biopsies<\/span><\/strong>It provides a strong basis for clinical assessment of the quality of donor kidneys and the decision of whether to transplant or not.<\/p>\n


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Case 2<\/strong><\/p>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n

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Basic donor information<\/span><\/strong>Male, 44 years old, height 168 cm, weight 65 kg, admitted to the emergency room with \"head trauma for 2 hours\". Diagnosis: severe craniocerebral injury. He had a history of hypertension, and his medication and control were unknown. He was admitted to the hospital and underwent debridement and decompression. Prior to the procedure, the donor had severe anemia, significant platelet drop, Hb 52g\/L, PLT 17*10^9\/L, high-dose norepinephrine to maintain blood pressure, and a urine output of 40-50 ml\/h. The baseline creatinine was 122umol\/L, and the last creatinine before the procedure was 311umol\/L. The donor had a history of hypertension, and his medications and control were unknown.<\/p>\n


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Access to donor kidneys<\/span><\/strong>: Acquisition was uneventful, no significant atherosclerotic plaque was seen in the renal artery, and the donor kidney was dark red in color.<\/p>\n


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Perfusion of donor kidneys<\/span><\/strong>: perfusion pressure of 35 mmHg, initial resistance index of 1.0, initial flow rate of 27 ml\/min. 2 hours after perfusion the resistance index was still above 0.55, the flow rate was below 55 ml\/min, and the improvement of the parameters after prolonged perfusion remained insignificant.<\/p>\n


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Specific perfusion parameters of the donor kidney<\/p>\n<\/section>\n

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A wedge resection biopsy of the donor kidney was performed, and the pathology suggested that about 45 glomerular structures were seen microscopically, of which 5 glomeruli were sclerotic, a small number of tubules were atrophied without obvious interstitial fibrosis, and the focal endothelium was mildly thickened, and diffuse microthrombosis was seen in the other about 40 glomeruli.<\/p>\n


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Pathologic biopsy of donor kidney<\/span><\/p>\n


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Donor kidney outcome<\/span><\/strong>:: Abandonment<\/p>\n


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Case summaries<\/span><\/strong>: In this case, the circulation was poorly maintained before donor acquisition, and the parameters were poor 2 hours after LifePort perfusion. According to the 2019 edition of the Technical Practice for Cadaveric Donor Kidney Cold Preservation by Extracorporeal Mechanical Perfusion, for donor kidneys with a post-perfusion resistance index of 0.4-0.6 and a perfusion flow rate of 50-80mL\/min, a comprehensive judgment is required in combination with the clinical data to determine the quality of the donor kidneys and decide whether or not to transplant. Therefore, clinical wedge resection biopsy of the donor kidney was performed, and the biopsy confirmed that diffuse microthrombosis was seen in a large number of glomeruli, which was not suitable for transplantation. We cannot rely solely on perfusion parameters to decide whether to discard a kidney, butPerfusion parameters remain an important basis for quality assessment of donor kidneys<\/span><\/strong>andIndications for invasive assessment modalities such as donor kidney biopsy<\/span><\/strong>.<\/p>\n


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Case 3<\/strong><\/p>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n

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Basic donor information<\/strong>: Female, 50 years old, diagnosis: ruptured cerebral aneurysm with hemorrhage combined with respiratory circulatory failure. Pre-acquisition blood creatinine was normal, and routine preoperative pathologic biopsy suggested a Remuzzi score of 3 in both kidneys.<\/span><\/p>\n


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Perfusion of donor kidneys<\/strong>The flow rate of the left kidney reached 90-120 ml\/min after 10 min of perfusion, and the resistance index fluctuated at 0.2-0.3. The flow rate of the right kidney reached 60 ml\/min after 1 h of perfusion, and then remained at this level, and the resistance index was maintained at about 0.4 at 1 h. The resistance index of the right kidney was about 0.4 at 1 h of perfusion.<\/span><\/p>\n


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Parametric plot of the left kidney LifePort machine during perfusion stabilization<\/p>\n

Actual perfusion time 3 hours<\/p>\n<\/section>\n


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Parametric plot of the right kidney LifePort machine when perfusion is stabilized<\/span><\/p>\n

Actual perfusion time 3 hours<\/span><\/p>\n<\/section>\n


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Postoperative condition of the patient<\/span><\/strong>: Left kidney recipient, male, 41 years old, diagnosed with uremia and unknown primary disease. The patient's urine output fluctuated between 1500-8000 ml per day for 10 days postoperatively. blood creatinine decreased to normal levels on the 4th postoperative day. The blood creatinine was reviewed at 5 months postoperative follow-up at 89umol\/l.<\/p>\n


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Blood creatinine recovery in left kidney recipients within 2 weeks after surgery<\/span><\/p>\n


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Right kidney recipient, male, 39 years old, diagnosed with uremia, primary disease unknown. The patient's urine output fluctuated between 1000-6000 ml per day for 10 days postoperatively. blood creatinine decreased to below 200 umol\/l on postoperative day 6 and to normal levels on postoperative day 14. Blood creatinine was reviewed at 5 months postoperative follow-up at 107umol\/l.<\/p>\n


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Recovery of blood creatinine in right kidney recipients within 2 weeks after surgery<\/span><\/p>\n


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Case summary<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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In this case, the donor kidneys were derived from 2 kidneys of the same donor, and both kidneys were assessed for quality prior to donation, with identical Remuzzi pathology scores. However, LifePort perfusion revealed that the left kidney could achieve high flow rates and low resistance at an early stage. In contrast, the right kidney had a low flow rate and high resistance, and the rate of decrease in resistance index was significantly slower than that of the contralateral donor kidney. In terms of postoperative recovery, the speed and degree of recovery of grafted renal function was significantly better in left kidney recipients than in right kidney recipients.<\/p>\n


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Thus, LifePort perfusion parameters are useful for clinical prediction of functional recovery of the transplanted kidney after surgery<\/strong><\/span>In particular, when there is a significant difference in perfusion parameters between 2 kidneys from the same donor, the clinic should be alerted to the possibility of slow recovery of renal function. Especially for 2 kidneys originating from the same donor, when there is a significant difference in perfusion parameters, it is necessary to be alert to the possibility of slow recovery of renal function after transplantation of the kidney with poor perfusion data, and the clinic needs to make timely medication adjustments and other interventions in order to promote faster and better recovery of transplanted kidney function.<\/p>\n<\/section>\n<\/section>\n<\/section>\n


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