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Swiss Med Wkly. 2019 Dec 23;149:w20143. doi: 10.4414/smw.2019.20143. eCollection 2019 Dec 16.

Impact of an intra-abdominal cooling device during open kidney transplantation in pigs.

Author information

1
Department of Vascular Surgery, Lausanne University Hospital and the University of Lausanne, Switzerland.
2
Visceral and Transplant Surgery, Department of Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland / Transplant Surgery, University of California San Francisco, CA, USA.
3
Visceral and Transplant Surgery, Department of Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland.
4
Division of Clinical Pathology, Department of Pathology and Immunology, Geneva University Hospital and Medical School, Geneva, Switzerland.
5
Department of Radiology and Medical Informatics, University of Geneva, Switzerland.
6
Transplantation Centre, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland.
7
Faculty of Science and Medicine, Section of Medicine, University of Fribourg, Switzerland.

Abstract

BACKGROUND:

Transplantation of kidneys from deceased donors is still associated with a high rate of postoperative renal dysfunction. During implantation into the recipient, the kidney rewarms. This second warm ischaemia time, which is not monitored, is harmful especially if prolonged. We recently developed an intra-abdominal cooling device that efficiently prevents kidney rewarming during robotic transplantation, and prevents ischaemia-reperfusion injuries. We tested the benefits of this cooling device during open kidney transplantation in pigs.

METHODS:

Kidneys were procured from large pigs by open bilateral nephrectomy. Following procurement, kidneys were flushed with 4°C Institut Georges Lopez-1 preservation solution, and placed on ice. Animals then underwent double sequential autologous open renal transplantation with (n = 7) and without (n = 6) intra-abdominal cooling.

RESULTS:

Mean anastomosis time was similar between groups (43.9 ± 13 minutes). At reperfusion, the renal cortex temperature was lower in the group with cooling (4.3 ± 1.1°C vs 26.5 ± 5.5°C, p <0.001). The cooled kidneys tended to be protected from injury, including some histopathological ischaemia-reperfusion lesions. With the device, kidneys had a better immediate postoperative urine output (p = 0.05).

CONCLUSION:

Our results indicate that the intra-abdominal cooling device significantly reduced second warm ischaemic time during transplantation, is technically safe and does not prolong anastomotic time.

PMID:
31869427
DOI:
10.4414/smw.2019.20143
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