A Novel Cooling Device for Kidney Transplant Surgery

Overview

Journal Surg Innov

Publisher Sage Publications

Specialty General Surgery

Date 2024 Jun 4

PMID 38831684

Authors

Ali Dergham

Luke Witherspoon

Liam Power

Joseph Y Nashed

Thomas A A Skinner

Affiliations

Soon will be listed here.

Abstract

Prolonged warm ischemia time (WIT) in kidney transplantation is associated with numerous adverse outcomes including delayed graft function and decreased patient and graft survival. Circumventing WIT lies in maintaining renal hypothermia and efficiently performing the vascular anastomosis during this portion of the procedure. Although numerous methods of intra-operative renal cooling have been proposed, most suffer from practical limitations, and none have been widely adopted. Herein we describe a novel device specifically designed to maintain renal hypothermia during kidney transplant surgery. Aluminum tubing was organized in a serpentine pattern to create a malleable, form-fitting cooling jacket to manipulate renal allografts during transplant surgery. Adult porcine kidneys were used to test the device with 4°C saline as coolant. Kidneys were placed at 24°C; surface and core temperatures were monitored using implanted thermocouples. Anastomosis of porcine kidney vessels to GORE-TEX® vascular grafts in an ex-vivo operative field was performed to assess the functionality of the device. The device maintained surface and core graft temperatures of ≤5°C after 60 minutes of WIT. Furthermore, the device provided hands-free retraction and support for the allograft. We found that ex-vivo anastomosis testing was enhanced by the presence of the cooling jacket. This proof-of-concept study demonstrated that our novel device is a practical tool for renal transplantation and can maintain sufficiently cool graft temperatures to mitigate WIT in an ex-vivo setting. This device is the first of its kind and has the potential to improve kidney transplant outcomes by eliminating WIT during graft implantation.

References

Ward J . Determination of the Optimum temperature for regional renal hypothermia during temporary renal ischaemia. Br J Urol. 1975; 47(1):17-24. DOI: 10.1111/j.1464-410x.1975.tb03913.x. View

Kuipers T, Hellegering J, El Moumni M, Krikke C, Haveman J, Berger S . Kidney temperature course during living organ procurement and transplantation. Transpl Int. 2016; 30(2):162-169. DOI: 10.1111/tri.12892. View

Tennankore K, Kim S, Alwayn I, Kiberd B . Prolonged warm ischemia time is associated with graft failure and mortality after kidney transplantation. Kidney Int. 2016; 89(3):648-58. DOI: 10.1016/j.kint.2015.09.002. View

Anderson C, Graff R, NEWTON W . A method of facilitating renal transplantation with the use of stockinet. Am J Surg. 1973; 126(1):124-5. DOI: 10.1016/s0002-9610(73)80112-6. View

Forsythe J, Dunnigan P, Proud G, Lennard T, Taylor R . Reducing renal injury during transplantation. Br J Surg. 1989; 76(10):999-1001. DOI: 10.1002/bjs.1800761004. View

Szostek M, Kosieradzki M, Chmura A, Pacholczyk M, Lagiewska B, Adadynski L . Does "second warm ischemia time" play a role in kidney allograft function?. Transplant Proc. 1999; 31(1-2):1037-8. DOI: 10.1016/s0041-1345(98)01892-2. View

Pupka A, Chudoba P, Patrzalek D, Janczak D, Szyber P . The modification of renal transplantation with the usage of own polyethylene receptacle. Polim Med. 2003; 33(3):33-7. View

Desgrandchamps F, Eugene M, Tuchschmid Y, Muller F, Teillac P, IDATTE J . [Cooling shell in renal transplantation. Thermometric evaluation of a prototype]. Prog Urol. 1996; 6(1):25-9. View

Feuillu B, Cormier L, Frimat L, Kessler M, Amrani M, Mangin P . Kidney warming during transplantation. Transpl Int. 2003; 16(5):307-12. DOI: 10.1007/s00147-003-0549-7. View

10.

Minor T, von Horn C, Paul A . Role of temperature in reconditioning and evaluation of cold preserved kidney and liver grafts. Curr Opin Organ Transplant. 2017; 22(3):267-273. PMC: 5617555. DOI: 10.1097/MOT.0000000000000402. View

11.

Schopp I, Reissberg E, Luer B, Efferz P, Minor T . Controlled Rewarming after Hypothermia: Adding a New Principle to Renal Preservation. Clin Transl Sci. 2015; 8(5):475-8. PMC: 4744687. DOI: 10.1111/cts.12295. View

12.

Szostek M, Pacholczyk M, Lagiewska B, Danielewicz R, Walaszwski J, Rowinski W . Effective surface cooling of the kidney during vascular anastomosis decreases the risk of delayed kidney function after transplantation. Transpl Int. 1996; 9 Suppl 1:S84-5. DOI: 10.1007/978-3-662-00818-8_22. View

13.

Damasceno-Ferreira J, Bechara G, Costa W, Pereira-Sampaio M, Sampaio F, Benchimol de Souza D . The relationship between renal warm ischemia time and glomerular loss. An experimental study in a pig model. Acta Cir Bras. 2017; 32(5):334-341. DOI: 10.1590/s0102-865020170050000002. View

14.

Hameed A, Yuen L, Pang T, Rogers N, Hawthorne W, Pleass H . Techniques to Ameliorate the Impact of Second Warm Ischemic Time on Kidney Transplantation Outcomes. Transplant Proc. 2018; 50(10):3144-3151. DOI: 10.1016/j.transproceed.2018.09.003. View

15.

Kaminska D, Koscielska-Kasprzak K, Chudoba P, Klinger M . Kidney Injury Due to Warm Ischemia During Transplantation Can Be Reduced. Am J Transplant. 2015; 16(5):1639. DOI: 10.1111/ajt.13641. View

16.

Lepiesza A, Chudoba P, Kaminska D, Pupka A, Zaleska P . [Methods of Reduction of Warm Ischemic Time in Kidney Transplantation and Their Role of Early and Late Outcomes]. Polim Med. 2017; 46(1):71-77. DOI: 10.17219/pim/62901. View

17.

Vinson A, Rose C, Kiberd B, Odutayo A, Kim S, Alwayn I . Factors Associated With Prolonged Warm Ischemia Time Among Deceased Donor Kidney Transplant Recipients. Transplant Direct. 2018; 4(5):e342. PMC: 5959340. DOI: 10.1097/TXD.0000000000000781. View

18.

Menon M, Sood A, Bhandari M, Kher V, Ghosh P, Abaza R . Robotic kidney transplantation with regional hypothermia: a step-by-step description of the Vattikuti Urology Institute-Medanta technique (IDEAL phase 2a). Eur Urol. 2014; 65(5):991-1000. DOI: 10.1016/j.eururo.2013.12.006. View

19.

Heylen L, Pirenne J, Samuel U, Tieken I, Naesens M, Sprangers B . The Impact of Anastomosis Time During Kidney Transplantation on Graft Loss: A Eurotransplant Cohort Study. Am J Transplant. 2016; 17(3):724-732. DOI: 10.1111/ajt.14031. View

20.

Laven B, Kasza K, Rapp D, Orvieto M, Lyon M, Oras J . A pilot study of ice-slurry application for inducing laparoscopic renal hypothermia. BJU Int. 2006; 99(1):166-70. DOI: 10.1111/j.1464-410X.2006.06518.x. View