Improving assessment criteria of transplant kidneys
Demand for transplant kidneys has been rising faster than the availability of donor kidneys, so kidney patients must often spend longer on waiting lists. To meet this demand, kidneys are increasingly being transplanted that would have previously not been considered based on factors such as age of donors, and quality of kidneys. This poses a higher risk of post-transplant complications, poorer transplant function and rejection.
A technique known as normothermic machine perfusion (NMP) has been developed to assess the quality of borderline kidneys and potentially to deliver therapies pre-transplant to improve the recovery of the kidney after transplantation. NMP to assess kidney viability has facilitated the successful use of kidneys previously considered unsuitable for transplant. However, this technique and assessment can be improved to make better informed transplant decisions and thus allow a wider range of kidneys to be transplanted safely.
Performing additional assessments
Joanne Devlin, a PhD student under the supervision of Mr John Asher from Queen Elizabeth University Hospital in Glasgow is hoping to work towards improving NMP. They have identified that the current NMP assessments consider blood flow in the kidneys, the amount of urine produced and appearance of the kidneys, after which a score is given.
Joanne believes that additional assessments can be done to increase confidence in the quality of the kidneys. She will focus on examining kidneys currently considered to be at risk of failure but potentially transplantable with further assessment. She will carry out NMP on these kidneys and add novel imaging techniques and measurement of biomarkers of cellular injury to assess them. This imaging assessment will be done during perfusion. The biochemical assessment of the kidneys will measure various markers that will provide information about the quality of the kidneys during perfusion.
It is hoped that this research will help to make an objective score of the quality of borderline kidneys. This could help clinicians make decisions on whether to transplant a kidney that would have otherwise been discarded, which could in turn make more kidneys available for transplant, reducing patient’s waiting times.
John said: "This is a brilliant opportunity to expand our work into viability assessment and will allow us to safely expand criteria for transplantation, bringing the advantages of a transplant to more kidney patients."
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