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In renal transplantation, delayed graft function is defined as the need for dialysis within the first week after kidney transplantation, resulting in longer hospitalization, increased costs and reduced graft survival.
Hypothermic machine perfusion, compared with static cold storage, is a better kidney preservation method prior to transplantation as it reduces delayed graft function rates and increases one-year survival rates, especially in asystolic and expanded criteria donors. In addition, it has the potential to minimize kidney discard rates. In Argentina, DGF rates are higher than the international average, thus the Argentine Transplant Authority (INCUCAI) decided to incorporate two hypothermic perfusion machines into the transplant system, and Argerich Hospital in the City of Buenos Aires was chosen for perfusion. To assess feasibility and minimize risks, it was decided to implement first a pilot plan for the perfusion of kidneys previously discarded for transplantation.
Objective: To assess the logistics, safety and connection to hypothermic perfusion machines of kidneys discarded for transplantation.
The kidneys were ablated in different institutions, transported to INCUCAI and, subsequently, to Argerich Hospital. Travel times from INCUCAI to Argerich Hospital were assessed; culture tests of pre- and post-perfusion preservation solutions were performed; a wedge biopsy was obtained before starting perfusion; and after surgical preparation, kidneys were placed in the HPM.
Ten deceased-donor kidneys previously discarded for transplantation were perfused.
The following times were obtained: Transportation from INCUCAI to Argerich Hospital: 60 min (45-75); transfer to Argerich Hospital’s 3rd floor - OR: 10 min; kidney preparation surgery: 30 min (20-45); and perfusion: 80 min (50-150).
Culture tests: Skin or surface germs were observed, with equal or fewer germs after perfusion; pre-perfusion negative cultures remained negative after perfusion. Two incorrectly bagged kidneys showed intestinal content germs.
Anatomopathological examination: Tubules: mild acute tubular necrosis in 5 and extensive ATN in 5.Interstitium: mild fibrosis in 7 and normal (unremarkable) in 3. Vessels: mild myointimal thickening in 5, moderate in 3 and normal vessels in 2.
The 10 kidneys were placed in the HPM, yielding flow and resistance values that were not assessed in this stage
The times observed were the ones expected for our health care system. The procedure was safe, with equal or less isolation of germs after perfusion. The two incorrectly bagged kidneys showed germs associated with intestinal content contamination. The 10 kidneys were successfully connected to the HMP. Even though flow and resistance values were obtained, they were not assessed in this stage. The most frequent anatomopathological findings were ATN and chronic lesions of donors. This first experience in Argentina shows INCUCAI’s health care decision to improve transplants and Argerich Hospital’s optimal adaptation to this practice.