The main objective of static cold storage is to reduce cellular metabolic demands to extend the period of ischaemia prior to transplantation. Hypothermia does not halt metabolism and the absence of oxygen causes a cellular shift toward anaerobic respiratory pathways.
There is emerging evidence that the introduction of oxygenation during organ preservation may help ameliorate the degree of ischaemia reperfusion injury and improve post-transplantation outcomes.
This review aims to appraise and summarise all published literature that utilises oxygenation to improve kidney preservation for purposes of transplantation.
We performed a scoping review of the literature using the bibliographic databases Embase and MEDLINE. The final date for searches was 20 March 2021. All research studies included were those that reported oxygen delivery during kidney preservation as well as providing a description of the oxygenation technique.
17 human and 48 animal studies met the inclusion criteria. The oxygen delivery methods investigated included hypothermic oxygenated machine perfusion (HOPE), oxygen carriers, two-layer method, venous systemic persufflation, hyperbaric oxygenation, normothermic machine perfusion and sub-normothermic machine perfusion.
The COMPARE trial was the only study carried out with the most methodological robustness being a randomised, double blind, controlled, phase III trial that investigated the efficacy of HOPE versus HMP.
A variety of studies reflect the evolution of oxygenation with useful lessons and encouraging outcomes. The first in human studies investigating HOPE and oxygen carriers are most robustly investigated strategies for oxygenation during kidney preservation and are, therefore, the best clinical references.
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Controlled Oxygenated Rewarming
Cold storage with an oxygen carrier supplementation
Dead Brain Donor
Donation after Cardiac Death
Delayed Graft Function
Expanded Criteria Donor
Hemopure® (HbO2 Therapeutics LLC, Waltham, MA)
Hypothermic Machine Perfusion
Hypothermic Machine Perfusion with an Oxygen Carrier
Hypothermic Oxygenated Machine Perfusion
Hypothermic Oxygenated Machine PErfusion with an Oxygen Carrier
HEMO2Life® (Hemarina, Morlaix, France)
Normothermic Machine Perfusion
Red Blood Cells
Sub-Normothermic Machine Perfusion
Two Layer Method
Venous Systemic Oxygen Persufflation
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Mesnard, B., Ogbemudia, A.E., Karam, G. et al. What is the evidence for oxygenation during kidney preservation for transplantation in 2021? A scoping review. World J Urol (2021). https://doi.org/10.1007/s00345-021-03757-8
- Kidney transplantation
- Organ preservation
- Hypothermic oxygenated machine perfusion
- Oxygen carrier
- Venous systemic oxygen persufflation
- Hyperbaric Oxygenation
- Normothermic Machine Perfusion