Clinical assessment of renal ischaemic injury and the role of cryopreservation : peritoneal cooling in non-heart-beating donation and topical cooling for laparoscopic surgery

• Main Author: Navarro, Alex
• Published: University of Sunderland 2009
• Subjects: 617; Health Sciences
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.532020

The project aims focussed on three main areas of study; ischaemic injury assessment, laparoscopic renal cryopreservation and peritoneal cooling for non-heart-beating organ donation. The effects of renal ischaemia represent significant challenges for transplantation and urological surgery in that with sufficient unchecked ischaemic duration, permanent loss of function is inevitable. Prior to consideration of novel approaches to ischaemic protection, aimed at producing improved graft quality for transplantation and an increased safe operating times for partial renal resections, deficiencies in the literature regarding the efficacy of viability testing were targeted. Techniques of ischaemic injury assessment are intended to allow identification of retrieved kidneys which are likely to have lost the potential for adequate function if transplanted. Such organs can then be discarded, thus improving outcomes and decreasing rates of primary non-function. Results pertaining to ischaemic injury assessment provided support for protocols of viability assessment based on hypothermic machine perfusion. The effect of warm ischaemia on renal viability criteria has been successfully demonstrated in a large animal model, and novel approaches to the use of such assessments have been explored in order to maximise organ resource opportunities and utilisation. The project has made an important contribution in the technical approach to laparoscopic partial nephrectomy and laparoscopic renal hypothermia. The studies involving the ‘Newcastle Laparoscopic Renal Cooling Device’ succeeded in achieving ‘proof of concept’ with demonstration of effective renal cooling and preservation. Studies relating to preservation interventions in the porcine model of the uncontrolled NHBD have produced striking results. These results strongly suggest that uncontrolled NHBD centres employing cold in-situ perfusion approaches to preservation would be wise to consider supplementary techniques of organ cooling.