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

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.

Keywords

• death; donor; kidney transplantation; cold ischemia; perfusion