For Clinicians | Kidney Transplant

Information for Clinicians

Caring for Every Patient

Accunea understands the fundamentals of evidence-based practice and the decisions behind adopting a breakthrough device

SHOULD I USE THIS ORGAN?

The decision to transplant an organ or to discard it is one of the hardest a surgeon can make, particularly with the growing number of organs from older donors and those with comorbidities.

Discard rates average 15-20%, and rise with KDPI (36% 80-90, 63% 91-100)[1]. However, over-caution may be preventing thousands of dialysis-dependent patients from returning to a normal life[2], and condemning hundreds more to death each year.

Pre-transplantation biopsies, where performed, can provide additional reassurance over organ condition and likely final function, particularly from high risk donors[3]. But biopsy is not without controversy[4], and decisions regarding single or dual transplant remain difficult.

Accunea now provides clinicians with direct objective functional and metabolic measurements to suit a wide range of clinical practice - from hypothermic storage to normothermic reperfusion methodologies. With this evidence to hand, clinicians will find the hard decisions easier to make.

[1] Tanriover B, Mohan S, Cohen DJ, et al. Am J Transplant. 2014;14:404–15.

[2] Hosgood SA, Thomson E, Moore T, et al. Br J Surg 2017; 104(Suppl 3): 23

[3] Gandolfini I, Buzio C, Zanelli P, et al. Am J Transplant. 2014 Nov; 14(11): 2515–2525.

[4] Grifasi C, D'Alessandro V, D'Armiento M, et al. BMC Nephrol. 2014; 15: 207.

IS MY PATIENT RECOVERING NORMALLY?

Every transplant patient deserves an uncomplicated recovery, with the continuous smooth return to normal organ function. Unfortunately, many published Kaplan-Meier curves tell a different story - that the greatest rate of graft loss occurs in the first 30 days, affecting up to 6% of all transplants[1].

Current evidence shows that the time course of early changes in blood creatinine reflect long-term patient outcomes[2]. Mathematical models of this dynamic state can predict dialysis requirements and likely recovery of function[3]. This information helps not only with short-term dialysis decisions, but longer term outpatient monitoring.

Tissue glucose/lactate ratios have long been understood to reflect metabolic condition. This has been similarly demonstrated in porcine models of machine perfusion[4], a model immediately translatable to post-operative recovery.

Accunea now provides clinicians with continuous functional and metabolic indicators at the bedside to ensure an uneventful recovery, and allow for the tailoring of important drug dosages based upon real-time GFR. In addition, intelligent data pooling from multiple patient recoveries provides early warnings and notifications of likely deviations requiring intervention.

[1] Hamed MO, Chen Y, Pasea L, et al. Am J Transplant 2015; 15(6): 1632-1643

[2] Krogstrup NV, Bibby BM, Aulbjerg C, et al. Scand J Clin Lab Invest 2016; 76(4):319-323

[3] Pianta TJ, Endre ZH, Pickering JW, et al. PLoS ONE 2014; 10(5):e0125669

[4] Gowers SAN, Hamaoui K, Vallant N, et al. Analytical Methods 2018; 10:5273-5281