Evidence based hypothermic preservation of the kidney and liver for transplantation
<p>Improving the techniques used for the preservation of livers and kidneys for transplantation has the potential to enhance the outcomes of transplant procedures. With an ever increasing demand for suitable organs, we now turn to the use of organs that may once have been considered to have lo...
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| Format: | Thesis |
| Language: | English |
| Published: |
2014
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| Summary: | <p>Improving the techniques used for the preservation of livers and kidneys for transplantation has the potential to enhance the outcomes of transplant procedures. With an ever increasing demand for suitable organs, we now turn to the use of organs that may once have been considered to have lower success rates. The importance of preventing further damage to these organs during preservation is even greater than for standard organs. National and international guidelines for the use of such techniques in health service provision should be based upon the best level of evidence available; this is a particular challenge in a specialty with relatively few numbers of procedures each year.</p> <p>This thesis describes a cohesive group of complementary studies which analyse the comparative effectiveness of preservation fluids for the cold storage of kidney and liver allografts from deceased donors. It also describes the comparison of hypothermic machine perfusion with static cold storage of kidneys. The systematic reviews carried out have a wider scope than any previously conducted. A novel approach was also taken towards the analysis of survival outcomes after transplantation as described in multiple studies. This work includes an analysis of national registry data that is the only large-scale comparison between Marshall’s Solution and University of Wisconsin Solution for kidney preservation.</p> <p>There is limited trial evidence that suggests similarity between the effectiveness of current preservation fluids for kidney preservation, and good evidence that Celsior and University of Wisconsin Solutions are equivalent for liver preservation. Good randomised trial evidence suggests that hypothermic machine perfusion reduces delayed graft function of kidneys. Hypothermic machine perfusion may also result in improved graft survival, but robust evidence is not available for this. The continued use of Marshall’s Solution for kidney preservation in the UK results in equivalent adjusted outcomes compared to University of Wisconsin Solution.</p> |
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