Job Description
Introduction

From isobox to HMP: Why is it needed?

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Changing Donor Profile

When you think of organ donation, and more specifically the transport of organs, you probably envision an isobox with "Organ For Transplant" written on it in large letters. While this is certainly still a reality, the isobox is increasingly being replaced by more advanced technological preservation methods.

These more advanced preservation methods are necessary because the donor profile has evolved significantly in recent years. The typical young donor, who dies as a result of a severe accident, is now becoming the minority. On one hand, we see that organ donors are increasingly older, and on the other hand, we see a shift from DBD (donation after brain death) donors to DCD (donation after circulatory death) donors. This change in donor profile is beneficial in that it makes more organs available. However, it also results in more high-risk organs that present a greater number of complications.

When we specifically look at kidneys, we see that these older and DCD donor kidneys have a significantly higher risk of DGF (Delayed Graft Function), which is defined by the need for dialysis in the first week post-transplant.

Now, you might wonder why the need for dialysis in the first week post transplant is an isue, considering these transplant patients required dialysis multiple times a week before their transplant.

Well, the presence of DGF leads to a more complicated post-operative course both in the short and long term. It affects the following areas:

  1. There is an increased risk of losing the kidney.

  2. There is a need for a different regimen of immunosuppressive medication.

  3. There is a need for dialysis, which always carries risks.

  4. There is an extended hospital stay.

  5. All of these factors result in additional costs.

DGF: An issue?

The impact of DGF on long term

The figure on the right illustrates the impact of DGF on graft functionality, the need for dialysis, and mortality 10 years post-transplantation. This figure clearly demonstrates that DGF is not merely "a dialysis session in the first week after transplantation." It can have a significant impact on the transplanted patient, even years after the transplantation.

Tackling DGF

Reducing delayed graft function (DGF) has long been a primary focus of scientific research in kidney transplantation.

Numerous strategies have been developed to mitigate DGF risk across all phases of the process—from organ donation to transplantation. Among these, hypothermic machine perfusion (HMP) during kidney preservation stands out as one of the most effective interventions for significantly lowering DGF incidence.

Scientific Literature

  • The New England Journal Of Medicine

  • The Lancet

  • Transplant International