Protection From Second Warm Ischemic Injury Using a Thermal Barrier Bag in Kidney Transplantation

Kentaro Ide, MD, PhD; Ryosuke Nakano, MD, PhD; Yuki Imaoka, MD, PhD; Hiroshi Sakai, MD, PhD; Kosuke Ono, MD; Naoki Tanimine, MD, PhD; Hiroyuki Tahara, MD, PhD; Masahiro Ohira, MD, PhD; Keiko Ueda, MD, PhD; Taizo Hirata, MD, PhD; Eiji Kobayashi, MD, PhD; Hideki Ohdan, MD, PhD

doi:10.1097/TXD.0000000000001454

Transplantation Direct (Mar 2023)

Protection From Second Warm Ischemic Injury Using a Thermal Barrier Bag in Kidney Transplantation

Kentaro Ide, MD, PhD,
Ryosuke Nakano, MD, PhD,
Yuki Imaoka, MD, PhD,
Hiroshi Sakai, MD, PhD,
Kosuke Ono, MD,
Naoki Tanimine, MD, PhD,
Hiroyuki Tahara, MD, PhD,
Masahiro Ohira, MD, PhD,
Keiko Ueda, MD, PhD,
Taizo Hirata, MD, PhD,
Eiji Kobayashi, MD, PhD,
Hideki Ohdan, MD, PhD

Affiliations

Kentaro Ide, MD, PhD: 1 Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Ryosuke Nakano, MD, PhD: 1 Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Yuki Imaoka, MD, PhD: 1 Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Hiroshi Sakai, MD, PhD: 1 Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Kosuke Ono, MD: 1 Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Naoki Tanimine, MD, PhD: 1 Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Hiroyuki Tahara, MD, PhD: 1 Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Masahiro Ohira, MD, PhD: 1 Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Keiko Ueda, MD, PhD: 2 Clinical Research Center in Hiroshima, Hiroshima University Hospital, Hiroshima, Japan.
Taizo Hirata, MD, PhD: 2 Clinical Research Center in Hiroshima, Hiroshima University Hospital, Hiroshima, Japan.
Eiji Kobayashi, MD, PhD: 3 Department of Kidney Regenerative Medicine, The Jikei University School of Medicine, Tokyo, Japan.
Hideki Ohdan, MD, PhD: 1 Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.

DOI: https://doi.org/10.1097/TXD.0000000000001454
Journal volume & issue: Vol. 9, no. 3
p. e1454

Abstract

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Background. Second warm ischemic injury during vascular anastomosis not only adversely affects immediate posttransplant function but also affects long-term patient and graft survival. We developed a pouch-type thermal barrier bag (TBB) composed of a transparent, biocompatible insulation material suitably designed for kidneys and conducted the first-in-human clinical trial. Methods. A living-donor nephrectomy was performed using a minimum skin incision procedure. After back table preparation, the kidney graft was placed inside the TBB and preserved during vascular anastomosis. The graft surface temperature was measured before and after vascular anastomosis using a noncontact infrared thermometer. After completion of the anastomosis, the TBB was removed from the transplanted kidney before graft reperfusion. Clinical data, including patient characteristics and perioperative variables, were collected. The primary endpoint was safety, which was assessed by evaluating adverse events. The secondary endpoints were the feasibility, tolerability, and efficacy of the TBB in kidney transplant recipients. Results. Ten living-donor kidney transplant recipients with a median age of 56 y (range, 39–69 y) were enrolled in this study. No serious adverse events related to the TBB were observed. The median second warm ischemic time was 31 (27–39) min, and the median graft surface temperature at the end of anastomosis was 16.1 °C (12.8–18.7 °C). Conclusions. TBB can maintain transplanted kidneys at a low temperature during vascular anastomosis, which contributes to the functional preservation of transplanted kidneys and stable transplant outcomes.

Published in Transplantation Direct

ISSN: 2373-8731 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: http://journals.lww.com/transplantationdirect/Pages/default.aspx

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