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Kidney Perfusion as an Organ Quality Assessment Tool—Are We Counting Our Chickens Before They Have Hatched?

by Julie De Beule 1 and Ina Jochmans 1,2,*
1
Laboratory of Abdominal Transplantation, Transplantation Research Group, Department of Microbiology, Immunology, and Transplantation, KU Leuven, 3000 Leuven, Belgium
2
Department of Abdominal Transplant Surgery, University Hospitals Leuven, 3000 Leuven, Belgium
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(3), 879; https://doi.org/10.3390/jcm9030879
Received: 26 February 2020 / Revised: 16 March 2020 / Accepted: 19 March 2020 / Published: 23 March 2020
The final decision to accept an organ for transplantation remains a subjective one. With “poor organ quality” commonly cited as a major reason for kidney discard, accurate, objective, and reliable quality assessment is essential. In an era of increasingly higher-risk deceased donor kidneys, the catch is to accept those where the risk–benefit scale will tip in the right direction. Currently available assessment tools, such as risk-scores predicting outcome and zero-time biopsy, perform unsatisfactory, and assessment options during static cold storage are limited. Kidney perfusion technologies are finding their way into clinical practice, and they bring a new opportunity to assess kidney graft viability and quality, both in hypothermic and normothermic conditions. We give an overview of the current understanding of kidney viability assessment during ex situ kidney perfusion. A pragmatic framework to approach viability assessment is proposed as an interplay of three different compartments: the nephron, the vascular compartment, and the immune compartment. Although many interesting ways to assess kidney injury and function during perfusion have been proposed, none have reached the stage where they can reliably predict posttransplant outcome. Larger well-designed studies and validation cohorts are needed to provide better guidance. View Full-Text
Keywords: machine perfusion; kidney preservation; quality assessment; viability assessment; vascular resistance; injury biomarkers; kidney perfusion machine perfusion; kidney preservation; quality assessment; viability assessment; vascular resistance; injury biomarkers; kidney perfusion
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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.

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