Greffons rénaux issus des donneurs décédés par arrêt circulatoire : optimisation du reconditionnement chez le donneur et de la conservation hypothermique

Abstract : Transplantation is the best alternative to end-stage renal disease. The shortage of grafts led the transplant teams to consider uncontrolled deceased donors after circulatory death (DCDs). These grafts suffered from a period of warm ischemia and are more vulnerable. Reconditioning methods in the donor by in situ cooling (ISC) and normothermic regional perfusion (NRP) have been developed to reduce the ischemia-reperfusion injuries. Each team has the choice as to the method and there are many different practices. After removal of kidneys, the use of hypothermic perfusion machines (HPM) is generally recommended. The optimization of reconditioning in the donor and hypothermic preservation appears as a major public health challenge. About optimization of the reconditioning method, the development of a high reproducible preclinical porcine model allowed to highlight the superiority of RNP over ISC. NRP duration of 4 hours minimum without exceeding 6 hours seems optimal. About hypothermic preservation, HPM allows to maintain the level of expression of the genes found at the end of RNP. The addition of active oxygenation to HPM or curcumin in static solution improves the graft outcomes in the short and long terms in a preclinical model of auto transplantation. This work could be extended to the study of other organs, other durations of warm ischemia and to controlled DCDs in order to further increase the number of transplantable grafts.
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Géraldine Allain. Greffons rénaux issus des donneurs décédés par arrêt circulatoire : optimisation du reconditionnement chez le donneur et de la conservation hypothermique. Urologie et Néphrologie. Université de Poitiers, 2018. Français. ⟨NNT : 2018POIT1410⟩. ⟨tel-02147081⟩

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