First in Man Renal Transplantation After Ex Vivo Normothermic Perfusion

Abstract

BACKGROUND: Normothermic perfusion is an alternative but little studied method of organ preservation. Herein, we report the first case of ex vivo normothermic renal transplant perfusion in man. METHODS: The 62-year-old extended criteria donor died of an intracranial hemorrhage and had undergone cardiopulmonary resuscitation for a 30-min cardiac arrest. After 11 hr of static cold storage and immediately before transplantation, the left kidney was perfused at a mean temperature of 33.9 °C for 35 min with a plasma-free red cell-based solution. The ex vivo perfusion circuit consisted of a centrifugal pump, a membrane oxygenator, and a heat exchanger. The paired right kidney underwent static cold storage for 14 hr. RESULTS: After transplantation, the 55-year-old female recipient of the normothermic perfused kidney had slow graft function but the patient remained dialysis independent; serum creatinine at 3 months posttransplant was 132 μmol/L. The paired static cold-stored kidney was transplanted into a 52-year-old male recipient. This kidney had delayed graft function for a period of 26 days, and the 3-month serum creatinine was 218 μmol/L. CONCLUSION: We conclude that ex vivo normothermic kidney perfusion with a plasma-free red cell-based solution is a feasible method of preservation. This first case was performed without compromising the transplant kidney.