Clin Transplant Res.  2024 Mar;38(1):52-56. 10.4285/kjt.23.0056.

Overcoming the longest cold ischemia time yet seen in Korea using hypothermic machine perfusion in deceased donor kidney transplantation: a case report

• Kim MJ
• Shin YH
• Kang J
• Ko T
• Chang WB

• KMID: 2555997
• DOI: http://doi.org/10.4285/kjt.23.0056

Abstract

To address a donor kidney shortage, marginal grafts have been applied in deceased donor kidney transplantation (DDKT). These grafts exhibit comparatively unfavorable outcomes, particularly when cold ischemia time (CIT) is prolonged. Hypothermic machine perfusion (HMP) has been investigated to mitigate the effects of prolonged CIT during graft transport. The present case involved successful management of the longest CIT recorded in Korea by employing HMP in DDKT. The donor was a 54-year-old man (Korean Kidney Donor Profile Index, 82%) with diabetes. The recipient, a 51-year-old man on peritoneal dialysis, had end-stage renal disease secondary to diabetic nephropathy. Following procurement, the left kidney was preserved using HMP. Inclement weather delayed graft transportation; consequently, the total CIT was 28 hours and 6 minutes, with the kidney preserved by HMP for 22 hours and 35 minutes. Postoperative graft function gradually recovered, and urine output was satisfactory. Delayed graft function was not observed, and the patient was discharged on postoperative day 13 without significant complications. Five months after surgery, his serum creatinine level was 1.7 mg/dL. Successful DDKT with a marginal donor graft via HMP, despite the longest CIT yet observed in Korea, underscores the usefulness of HMP in enhancing graft quality and preserving function.

Keyword

Deceased donor; Kidney transplantation; Cold ischemia; Machine perfusion; Case report

Figure

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  Fig. 1 Hypothermic machine perfusion of a kidney graft, revealing an increase in flow rate and a decrease in resistance. The parameters displayed, from left to right, include flow pressure (mmHg, high/low), flow rate (mL/min), resistance (mmHg/mL/min), temperature (°C, ice/container), and patient information.

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  Fig. 2 Kidney Doppler results from (A) postoperative day (POD) 1 and (B) POD 12, which demonstrate satisfactory vascular flow. The resistive index (RI) values fall within the normal range, with an RI of 0.65 on POD 1 and 0.67 on POD 12.

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  Fig. 3 Preoperative and postoperative urine output and creatinine levels of the recipient. The data indicate adequate daily urine output, and a gradual decrease was observed in serum creatinine levels from preoperative day (PrOP) 1 onward, without delayed graft function. POD, postoperative day; POM, postoperative month.

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