Hosgood, SA

Kleverlaan, TF

Nicholson, ML

Radford, Lac

Apollo (Cambridge)

The Carrel patch clamp for renaltransplantationLAC Radford, TF Kleverlaan, SA Hosgood, ML NicholsonDepartment of Surgery, University of Cambridge, Addenbrooke’sHospital, Cambridge, UKCORRESPONDENCE TOMichael Nicholson, E: mln31@cam.ac.ukdoi 10.1308/rcsann.2017.0080BACKGROUNDNormothermic machine perfusion (NMP) is a novel technique forassessing and reconditioning transplant kidneys.1 NMP involves recir-culating a red cell-based perfusate through the kidney at near physio-logical conditions.1–3 The NMP arterial cannula has previously beensecured with a ligature at the origin of the renal artery. This damagesthe aortic patch, which must be excised prior to transplantation. Wedescribe a novel clamp used to preserve the aortic Carrel patch.TECHNIQUEThe Carrel patch is threaded through one end of the clamp (Fig 1). Theclamp is closed (Fig 2) and the screw-threaded pin is tightened, creat-ing a secure seal for attachment to the NMP circuit. The patch clampalso allows preservation of the Carrel patch in kidneys with multiplearteries (Figs 2 and 3). Centralisation of the renal artery within theclamp maximises the seal and size of the patch. Single-use plastic orstainless steel clamps which can be sterilised are available in differentsizes.DISCUSSIONA Carrel patch facilitates anastomosis of the renal artery to the iliacarterial system and reduces vascular complications.4 Direct renal arterycannulation for NMP necessitates excision of the aortic patch and car-ries the risk of creating an intimal flap. The Carrel patch clamp is aninnovation that preserves the aortic patch and eliminates the risks ofdirect cannula damage.ACKNOWLEDGEMENTSThe authors wish to thank the Institut Georges Lopez (Lissieu, France)and Organ Assist (Warsaw, Poland) for producing the Carrel patchclamp. The research was funded by the National Institute for HealthResearch Blood and Transplant Research Unit (NIHR BTRU) in OrganDonation and Transplantation at the University of Cambridge in collab-oration with Newcastle University and in partnership with NHS Bloodand Transplant (NHSBT). The views expressed are those of the authorsand not necessarily those of the NHS, the NIHR, the Department ofHealth or NHSBT.References1. Hosgood SA, Patel M, Nicholson ML. The conditioning effect of ex vivo normo-thermic perfusion in an experimental kidney model. J Surg Res 2013; 182(1):153–160.2. Hosgood SA, Saeb-Parsy K, Hamed MO et al. Successful transplantation ofhuman kidneys deemed untransplantable but resuscitated by ex vivo normother-mic machine perfusion. Am J Transplant 2016; 16(11): 3,282–3,285.3. Hosgood SA, Nicholson ML. First in man renal transplantation after ex vivo nor-mothermic perfusion. Transplantation 2011; 92(7): 735–738.4. Bewick M, Ogg CS, Parsons V et al. The arterial complications of 500 renaltransplants. Proc Eur Dialysis Transplant Assoc 1976; 13: 186–190.Figure 1 Carrel patch threaded through one half of the patchclampFigure 2 Clamp closed around Carrel patch (with multiplearteries) and secured with threaded pinFigure 3 Clamp in situ during normothermic machineperfusion with multiple arteries secured664 Ann R Coll Surg Engl 2017; 99: 658–664TECHNICAL SECTION

The Carrel patch clamp for renal transplantation.

https://www.repository.cam.ac.uk/bitstream/1810/291347/3/rcsann.2017.0080.pdf

The Carrel patch clamp for renal transplantation.

Abstract

Similar works

Full text

Available Versions

Apollo (Cambridge)