A szervtranszplantáció területén évek óta fennálló probléma az egyre növekvő szervigény mellett az elérhető donorszervek számának stagnálása. Az ellentét feloldására tett kísérletek több irányból közelítették meg a kérdést: egyrészről a donorkritériumok kiterjesztésével, másrészt az eltávolított szervek minőségének megőrzésére kidolgozott gépi perfúzió módszerével, melynek használata bizonyítottan csökkenti a késve meginduló graftműködés előfordulását, és javítja a grafttúlélést. Ezek az előnyök különösen a kiterjesztett kritériumú donáció tekintetében kifejezettek. A vesetranszplantáció során egyre szélesebb körben alkalmazzák a gépi perfúziót; jelenleg a legelterjedtebb formája a hypothermiás gépi perfúzió, azonban egyre több érv szól a normothermiás eljárás mellett is. Az alkalmazott modalitástól függően nemcsak szervkonzerválásra, de szervkondicionálásra is van lehetőség. Napjainkban számos kutatás folyik a gépi perfúzió során alkalmazható terápiás lehetőségekről, melyek a jövőben fontos szerepet játszhatnak az ischaemia-reperfúziós károsodás és az immunizáció csökkentésében. Közleményünkben a kiterjesztett kritériumú donáció rövid áttekintését követően összefoglaljuk a gépi perfúzió alkalmazási módjait, aktuális eredményeit, valamint diagnosztikus és terápiás lehetőségeit a vesetranszplantáció területén. Orv Hetil. 2023; 164(9): 339–347.
Metzger RA, Delmonico FL, Feng S, et al. Expanded criteria donors for kidney transplantation. Am J Transplant. 2003; 3(Suppl 4): 114–125.
Baskin-Bey ES, Kremers W, Stegall MD, et al. United network for organ sharing’s expanded criteria donors: is stratification useful? Clin Transplant. 2005; 19: 406–412.
Rao PS, Schaubel DE, Guidinger MK, et al. A comprehensive risk quantification score for deceased donor kidneys: the kidney donor risk index. Transplantation 2009; 88: 231–236.
Nagy I, Varga AK, Balázsfalvi N, et al. Analysis of the acceptance practice of deceased donor kidneys in a single Hungarian transplant centre. [A kadáverdonor-vesék elfogadási gyakorlatának vizsgálata a debreceni transzplantációs centrumban.] Orv Hetil. 2021; 162: 1022–1028. [Hungarian]
Frei U, Noeldeke J, Machold-Fabrizii V, et al. Prospective age-matching in elderly kidney transplant recipients – a 5-year analysis of the Eurotransplant Senior Program. Am J Transplant. 2008; 8: 50–57.
Pascual J, Zamora J, Pirsch JD. A systematic review of kidney transplantation from expanded criteria donors. Am J Kidney Dis. 2008; 52: 553–586.
Hwang JK, Park SC, Kwon KH, et al. Long-term outcomes of kidney transplantation from expanded criteria deceased donors at a single center: comparison with standard criteria deceased donors. Transplant Proc. 2014; 46: 431–436.
Ferreira E, Costa J, Romãozinho C, et al. Long-term outcomes of kidney transplantation from expanded-criteria deceased donors: a single-center experience. Transplant Proc. 2017; 49: 770–776.
Perico N, Cattaneo D, Sayegh MH, et al. Delayed graft function in kidney transplantation. Lancet 2004; 364: 1814–1827.
Cavaillé-Coll M, Bala S, Velidedeoglu E, et al. Summary of FDA workshop on ischemia reperfusion injury in kidney transplantation. Am J Transplant. 2013; 13: 1134–1148.
Childress JF, Liverman CT. (eds.) Organ donation: opportunities for action. National Academies Press, Washington, DC, 2006.
Rao PS, Ojo A. The alphabet soup of kidney transplantation: SCD, DCD, ECD – fundamentals for the practicing nephrologist. Clin J Am Soc Nephrol. 2009; 4: 1827–1831.
Machado C. The first organ transplant from a brain-dead donor. Neurology 2005; 64: 1938–1942.
Thuong M, Ruiz A, Evrard P, et al. New classification of donation after circulatory death donors definitions and terminology. Transpl Int. 2016; 29: 749–759.
Gardiner D, Charlesworth M, Rubino A, et al. The rise of organ donation after circulatory death: a narrative review. Anaesthesia 2020; 75: 1215–1222.
Perner F, Szenohradszky P, Szederkényi E, et al. Organ preservation. In: Perner F, Petrányi Gy. (eds.) Organ transplantation. [Perner F, Szenohradszky P, Szederkényi E, et al. A szervkonzerválás. In: Perner F, Petrányi Gy. (szerk.) Szervátültetés.] Medicina Könyvkiadó, Budapest, 2013; p. 115.
Jing L, Yao L, Zhao M, et al. Organ preservation: from the past to the future. Acta Pharmacol Sin. 2018; 39: 845–857.
Tingle SJ, Figueiredo RS, Moir JA, et al. Machine perfusion preservation versus static cold storage for deceased donor kidney transplantation. Cochrane Database Syst Rev. 2019; 3: CD011671.
Jochmans I, Akhtar MZ, Nasralla D, et al. Past, present, and future of dynamic kidney and liver preservation and resuscitation. Am J Transplant. 2016; 16: 2545–2555.
Radajewska A, Krzywonos-Zawadzka A, Bil-Lula I. Recent methods of kidney storage and therapeutic possibilities of transplant kidney. Biomedicines 2022; 10: 1013.
Hosgood SA, Brown RJ, Nicholson ML. Advances in kidney preservation techniques and their application in clinical practice. Transplantation 2021; 105: e202–e214.
Zulpaite R, Miknevicius P, Leber B, et al. Ex-vivo kidney machine perfusion: therapeutic potential. Front Med (Lausanne) 2021; 8: 808719.
Brat A, De Vries KM, Van Heurn EW, et al. Hypothermic machine perfusion as a national standard preservation method for deceased donor kidneys. Transplantation 2022; 106: 1043–1050.
Matsuoka L, Shah T, Aswad S, et al. Pulsatile perfusion reduces the incidence of delayed graft function in expanded criteria donor kidney transplantation. Am J Transplant. 2006; 6: 1473–1478.
Savoye E, Macher M-A, Videcoq M, et al. Evaluation of outcomes in renal transplantation with hypothermic machine perfusion for the preservation of kidneys from expanded criteria donors. Clin Transplant. 2019; 33: e13536.
Foucher Y, Fournier MC, Legendre C, et al. Comparison of machine perfusion versus cold storage in kidney transplant recipients from expanded criteria donors: a cohort-based study. Nephrol Dial Transplantat. 2020; 35: 1051–1059.
Kron P, Schlegel A, de Rougemont O, et al. Short, cool, and well oxygenated – HOPE for kidney transplantation in a rodent model. Ann Surg. 2016; 264: 815–822.
Jochmans I, Brat A, Davies L, et al. Oxygenated versus standard cold perfusion preservation in kidney transplantation (COMPARE): a randomised, double-blind, paired, phase 3 trial. Lancet 2020; 396: 1653–1662. Erratum: Lancet 2021; 396: 1978.
Darius T, Nath J, Mourad M. Simply adding oxygen during hypothermic machine perfusion to combat the negative effects of ischemia-reperfusion injury: fundamentals and current evidence for kidneys. Biomedicines 2021; 9: 993.
Woodside KJ, Goldfarb DA, Rabets JC, et al. Enhancing kidney function with thrombolytic therapy following donation after cardiac death: a multicenter quasi-blinded prospective randomized trial. Clin Transplant. 2015; 29: 1173–1180.
Moser MA, Arcand S, Lin HB, et al. Protection of the transplant kidney from preservation injury by inhibition of matrix metalloproteinases. PLOS ONE 2016; 11: e0157508.
Rampino T, Gregorini M, Germinario G, et al. Extracellular vesicles derived from mesenchymal stromal cells delivered during hypothermic oxygenated machine perfusion repair ischemic/reperfusion damage of kidneys from extended criteria donors. Biology (Basel) 2022; 11: 350.
Bhattacharjee RN, Ruthirakanthan A, Sun Q, et al. Subnormothermic oxygenated perfusion optimally preserves donor kidneys ex vivo. Kidney Int Rep. 2019; 4: 1323–1333.
Hamar M, Selzner M. Ex-vivo machine perfusion for kidney preservation. Curr Opin Organ Transplant. 2018; 23: 369–374.
Minor T, von Horn C, Gallinat A, et al. First-in-man controlled rewarming and normothermic perfusion with cell-free solution of a kidney prior to transplantation. Am J Transplant. 2020; 20: 1192–1195.
Zlatev H, von Horn C, Kaths M, et al. Clinical use of controlled oxygenated rewarming of kidney grafts prior to transplantation by ex vivo machine perfusion. A pilot study. Eur J Clin Invest. 2022; 52: e13691.
Von Horn C, Zlatev H, Kaths M, et al. Controlled oxygenated rewarming compensates for cold storage-induced dysfunction in kidney grafts. Transplantation 2022; 106: 973–978.
Hosgood SA, Nicholson ML. First in man renal transplantation after ex vivo normothermic perfusion. Transplantation 2011; 92: 735–738.
Urbanellis P, Hamar M, Kaths JM, et al. Normothermic ex vivo kidney perfusion improves early DCD graft function compared with hypothermic machine perfusion and static cold storage. Transplantation 2020; 104: 947–955.
Rijkse E, de Jonge J, Kimenai HJ, et al. Safety and feasibility of 2 h of normothermic machine perfusion of donor kidneys in the Eurotransplant Senior Program. BJS Open 2021; 5: zraa024.
Mazilescu LI, Urbanellis P, Kim SJ, et al. Normothermic ex vivo kidney perfusion for human kidney transplantation: first North American results. Transplantation 2022; 106: 1852–1859.
Hosgood SA, Callaghan C, Wilson C, et al. A randomised trial of normothermic machine perfusion versus static cold storage in donation after circulatory death renal transplantation. Br J Surg. 2022; 109(Suppl 4): znac242.006.
DiRito JR, Hosgood SA, Reschke M, et al. Lysis of cold-storage-induced microvascular obstructions for ex vivo revitalization of marginal human kidneys. Am J Transplant. 2021; 21: 161–173.
Yang C, Hosgood SA, Meeta P, et al. Cyclic helix B peptide in preservation solution and autologous blood perfusate ameliorates ischemia-reperfusion injury in isolated porcine kidneys. Transplant Direct. 2015; 1: e6.
Thompson ER, Sewpaul A, Figuereido R, et al. MicroRNA antagonist therapy during normothermic machine perfusion of donor kidneys. Am J Transplant. 2022; 22: 1088–1100.
Pool MB, Vos J, Eijken M, et al. Treating ischemically damaged porcine kidneys with human bone marrow- and adipose tissue-derived mesenchymal stromal cells during ex vivo normothermic machine perfusion. Stem Cells Dev. 2020; 29: 1320–1330.
Thompson ER, Bates L, Ibrahim IK, et al. Novel delivery of cellular therapy to reduce ischemia reperfusion injury in kidney transplantation. Am J Transplant. 2021; 21: 1402–1414.
Bhattacharjee RN, Richard-Mohamed M, Sun Q, et al. CORM-401 reduces ischemia reperfusion injury in an ex vivo renal porcine model of the donation after circulatory death. Transplantation 2018; 102: 1066–1074.
Tietjen GT, Hosgood SA, DiRito J, et al. Nanoparticle targeting to the endothelium during normothermic machine perfusion of human kidneys. Sci Transl Med. 2017; 9(418): eaam6764.
Ferdinand JR, Hosgood SA, Moore T, et al. Cytokine absorption during human kidney perfusion reduces delayed graft function-associated inflammatory gene signature. Am J Transplant. 2021; 21: 2188–2199.
Macmillan S, Hosgood SA, Nicholson ML. Enzymatic blood group conversion of human kidneys during ex vivo normothermic machine perfusion. Br J Surg. 2023; 110: 133–137.
Resch T, Cardini B, Oberhuber R, et al. Transplanting marginal organs in the era of modern machine perfusion and advanced organ monitoring. Front Immunol. 2020; 11: 631.
De Beule J, Jochmans I. Kidney perfusion as an organ quality assessment tool-are we counting our chickens before they have hatched? J Clin Med. 2020; 9: 879.
Bellini MI, Tortorici F, Amabile MI, et al. Assessing kidney graft viability and its cells metabolism during machine perfusion. Int J Mol Sci. 2021; 22: 1121.
Hosgood SA, Barlow AD, Hunter JP, et al. Ex vivo normothermic perfusion for quality assessment of marginal donor kidney transplants. Br J Surg. 2015; 102: 1433–1440.
Schutter R, van Varsseveld OC, Lantinga VA, et al. Magnetic resonance imaging during warm ex vivo kidney perfusion. Artif Organs 2023; 47: 105–116.
Eurotransplant Statistics Library. Document title: statistics.eurotransplant.org:9021P_2022.12:09.01.2023;statistics.eurotransplant.org:4008P_2022:09.01.2023. Available from: https://statistics.eurotransplant.org/ [accessed: Jan 11, 2023].
Nemes B, Fedor R, Kanyári Z, et al. First outcomes, since being full member of Eurotransplant. A single center experience of cadaveric kidney transplantation. [Eredményeink a teljes jogú Eurotransplant-tagság óta. A Debreceni Vesetranszplantációs Központ tapasztalatai.] Orv Hetil. 2016; 157: 925–937. [Hungarian]
Mihály S, Egyed-Varga A, Trnka-Szántay K, et al. [The impact of the COVID-19 pandemic on organ donation and transplantation in Hungary in 2020]. [A COVID–19-járvány hatása a szervadományozásra és -átültetésre Magyarországon 2020-ban.] Orv Hetil. 2021; 162: 890–896. [Hungarian]
Wettstein D, Hamar M, Cseprekál O, et al. Machine perfusion: new opportunities in abdominal organ transplantation. [Szervkonzerválás gépi perfúzióval: új lehetőségek a hasi szervek transzplantációjában.] Orv Hetil. 2018; 159: 1882–1890. [Hungarian]