Korean J Transplant.  2023 Jun;37(2):129-134. 10.4285/kjt.23.0017.

The first use of hypothermic machine perfusion in Korea to recover a procured kidney graft and prevent prolonged cold ischemic time: a case report

• Shin YH
• Ko T
• Park JH
• Chang WB

• KMID: 2544118
• DOI: http://doi.org/10.4285/kjt.23.0017

Abstract

To overcome the shortage of donor grafts in kidney transplantation (KT), the use of marginal grafts has evolved. However, prolonged cold ischemic time (CIT) is especially critical when using marginal grafts. Recently, hypothermic machine perfusion (HMP) has been used to overcome the negative effects of prolonged CIT, and we report the first use of HMP in Korea. The donor was a 58-year-old man with severe hypoxia (PaO₂ <60 mmHg, FiO₂ 100%) for 9 hours prior to procurement. The patient’s kidneys were the only organs accepted for transplantation, and both kidneys were assigned to Jeju National University Hospital. After procurement, the right kidney was preserved using HMP immediately, and the left kidney was directly transplanted into a patient with a CIT of 2 hours 31 minutes. The second operation was performed following the first, using the right kidney graft that had been preserved by HMP for 10 hours and 30 minutes. Although postoperative graft function gradually recovered in both patients, the serum creatinine level decreased faster in the HMP patient. Neither patient showed signs of delayed graft function, and both were discharged without significant complications. The short-term outcomes in this transplantation of mate kidney grafts demonstrated that graft function can be safely preserved using HMP, and that HMP is beneficial in overcoming the negative effects of prolonged CIT.

Keyword

Death; Donor; Kidney transplantation; Cold ischemia; Perfusion

Figure

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  Fig. 1 (A) The renal artery of the right kidney is connected to the seal ring after trimming in the bench after procurement. (B) This seal ring will be connected to a cannula for the circulation of perfusate in the hypothermic pump machine. The renal vein is open in the perfusate container for draining out.

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  Fig. 2 The transplanted kidney right after anastomosis of the renal artery and vein. Some purple areas of the kidney quickly turned pink. This kidney was preserved in the hypothermic perfusion machine before transplantation.

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  Fig. 3 The preoperative and postoperative (A) urine outputs and (B) creatinine levels of the two recipients. Both showed sufficient daily urine output from postoperative day (POD) 1. Although the serum creatinine level gradually decreased in both recipients, the rate of decrease was slightly faster in the recipient whose graft had been preserved via HMP before transplantation. SCS, static cold storage; HMP, hypothermic machine perfusion.

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  Fig. 4 (A) Kidney Doppler sonography on postoperative day 14 showing good vascular flow within the normal range of restrictive index (RI) in the static cold storage patient (RI, 0.84) and (B) the hypothermic machine perfusion patient (RI, 0.74).

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