Donation and preservation:strategies to improve quantity and quality of deceased donor kidneys

This thesis contains several studies designed to improve the quantity and quality of deceased donor kidneys. The first two chapters are studies focused on donation after unexpected circulatory death (uDCD), a type of donor not commonly used within the Netherlands. The first study describes the experience within a regional uDCD pilot and a second study going in depth in the demographical factors influencing the success of uDCD programs. Following these chapters the second part of this thesis is focused on how to preserve the kidneys donated as best as possible, using machine perfusion. It starts with an overview of the different opportunities within machine perfusion, ranging from the cold to normothermic perfusion and from within the body of the donor to just before transplantation and variations in between. The next chapter describes the medical evaluation of the implementation of hypothermic machine perfusion for deceased donor kidneys in het Netherlands, followed by an international randomised controlled trial of the beneficial effects of the addition of oxygen to hypothermic machine perfusion. The following chapter is a more in depth experimental study towards the effects of the addition of oxygen to the perfusion fluid by using an experimental porcine normothermic perfusion model to compare function after different modalities of preservation. The final chapter is a pilot study using proteomic profiles of perfusates of deceased donor kidneys to possibly predict graft function after transplantation, as a non-invase method to support the choice which kidneys to use to maximize the potential of the kidneys available