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Systematic review of techniques and devices used to avoid warm ischemia time injury during kidney transplantation

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Abstract

Purpose

The lack of a reliable and reproducible technique to ensure a constantly low temperature of the graft during kidney transplantation (KT) may be a cause of renal nonfunction. The aim of this review was to assess all the methods and devices available to ensure hypothermia during vascular anastomosis in KT.

Methods

A literature search was conducted through May 2022 using PubMed/Medline, Cochrane Library, Embase and Web of Science databases. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed to identify eligible studies. The review protocol was registered on PROSPERO (CRD42022326550).

Results

A total of 20 studies reporting on four hypothermia techniques met our inclusion criteria. Simple instillation of cold serum is not sufficient, the graft reaching up to 33 ℃ at the end of warm ischemia time (WIT). Plastic bags filled with ice slush have questionable efficiency. The use of a gauze jacket filled with ice-slush was reported in 12/20 studies. It ensures a graft temperature up to 20.3 ℃ at the end of WIT. Some concerns have been linked to potentially inhomogeneous parenchymal cooling and secondary ileus. Novel devices with continuous flow of ice-cold solution around the graft might overcome these limitations, showing a renal temperature below 20 ℃ at all times during KT.

Conclusion

The gauze filled with ice slush is the most common technique, but several aspects can be improved. Novel devices in the form of cold-ischemia jackets can ensure a lower and more stable temperature of the graft during KT, leading to higher efficiency and reproducibility.

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Availability of data and material

Data are available upon request to the corresponding author.

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Acknowledgements

We acknowledge Doc. Nicoletta Colombi, University of Turin, for her valuable contribution to the systematic literature search.

Funding

The study was not funded.

Author information

Authors and Affiliations

  1. Department of Urology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca-Napoca, Romania

    Iulia Andras, Teodora Telecan & Nicolae Crisan

  2. Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy

    Alberto Piana

  3. Department of Urology, Fundacio Puigvert, Autonoma University of Barcelona, Barcelona, Spain

    Paolo Verri, Andrea Gallioli, Michael Baboudjian, Alberto Breda & Angelo Territo

  4. Department of Urology and Kidney Transplantation, Toulouse University Hospital, Toulouse, France

    Thomas Prudhomme

  5. Hospital Universitario Ramon Y Cajal. Alcala University, Instituto Ramon Y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain

    Vital Hevia

  6. Aix-Marseille Université, Service de Chirurgie Urologique Et de Transplantation Rénale, CHU Conception, AP-HM, Marseille, France

    Michael Baboudjian & Romain Boissier

  7. Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy

    Riccardo Campi

  8. Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy

    Riccardo Campi

Authors
  1. Iulia Andras
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  2. Alberto Piana
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  3. Paolo Verri
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  4. Teodora Telecan
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  5. Andrea Gallioli
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  6. Thomas Prudhomme
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  7. Vital Hevia
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  8. Michael Baboudjian
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  9. Romain Boissier
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  10. Nicolae Crisan
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  11. Riccardo Campi
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  12. Alberto Breda
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  13. Angelo Territo
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Consortia

European Association of Urology (EAU) Young Academic Urologists (YAU) Kidney Transplantation Working Group, Arnhem, Netherlands

Contributions

Study concept and design: IA, AT. Acquisition of data: AP, PV, IA. Drafting of the manuscript: IA, AT. Critical revision of the manuscript for important intellectual content: TT, AG, TP, VH, MB, RB, NC, RC, AB, AT. Statistical analysis: None.

Corresponding author

Correspondence to Iulia Andras.

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The authors report no conflict of interest.

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The study was conducted in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Patient consent was not required due to the study design (review).

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Andras, I., Piana, A., Verri, P. et al. Systematic review of techniques and devices used to avoid warm ischemia time injury during kidney transplantation. World J Urol 41, 993–1003 (2023). https://doi.org/10.1007/s00345-023-04328-9

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  • DOI: https://doi.org/10.1007/s00345-023-04328-9

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