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

摘要

Abstract Background Kidney transplantation using deceased donors still suffers from high post-operative dysfunction rate. During implantation into the recipient, the kidney rewarms. This second warm ischemia 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 prevent ischemia-reperfusion injuries. Here, we tested the benefits of this cooling device during open kidney transplantation in pigs. Materials 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 for 128.5 ± 23.2 min. The cooling device was used to continuously cool down the kidney during the vascular anastomosis time. Methods Animals underwent double sequential autologous open renal transplantation with (n = 7) and without (n = 6) intra-abdominal cooling. Renal cortex temperature and urine output were monitored. The severity of the ischemia reperfusion lesions was analyzed by histology (modified Goujon score). Results Mean anastomosis time was similar between groups (43.9 ± 13 min). 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 ischemia–reperfusion lesions. With the device, kidneys had a better immediate post-operative urine output ( p=0.05 ). Conclusions Our results indicate that the intra-abdominal cooling device significantly reduces second warm ischemic time during transplantation, is technically safe, and does not prolong anastomotic time.