Overview

Warm blood flow (ex vivo normothermic perfusion or EVNP) is a treatment that may help your transplanted kidney.

This information explains:

• how a kidney is prepared for transplant
• what EVNP involves
• the benefits of having EVNP treatment
• the risks of having EVNP treatment
• any other options to EVNP treatment
• what happens after having EVNP treatment

The information should help you to decide if this treatment is right for you. If you have any questions or concerns, please contact us.

Preparing a kidney for transplant

When a kidney is removed from a person who has died (the deceased donor), the blood is removed using a cold liquid. The kidney is then stored in a box of ice until it is ready to be given (transplanted) to the person who needs the organ. This process is called static cold storage.

Static cold storage has been used in kidney transplantation for more than 30 years. It is the standard procedure used in most transplant centres around the world.

Static cold storage does not preserve the kidney perfectly. This means that the kidney might take longer to start working after the transplant.

About half of people who have a kidney transplant from a deceased donor might need to wait a while for the kidney to start working. This can take a few days or sometimes a few weeks.

About EVNP

Another option to static cold storage is to pump warm blood through the kidney before it is transplanted into you. This procedure uses a machine like the one used during open-heart surgery that is often called a bypass machine.

The process typically takes about 1 hour but might be longer if the team looking after you feel that this would be helpful. A member of the transplant team will explain this to you.

The blood used is donated blood. When the process is finished, the donated blood is flushed out of the kidney. This process is called EVNP.

The purpose of EVNP is to give the kidney blood and oxygen before we transplant it into you. This allows the kidney either to:

• recover from some of the damage caused by static cold storage
• be preserved for longer

Benefits of having EVNP treatment

People who have a kidney transplant that is slow to start working need dialysis until then. They:

• may feel unwell due to a build-up of toxins (poisons) in their body
• need regular ultrasound scans until the kidney starts working
• are likely to need one or more kidney biopsies (where tissue samples are taken) to make sure that their body is not rejecting the kidney
• are likely to spend longer in hospital because of this need for extra ultrasound scans and biopsies

EVNP may:

• increase the chance of your kidney working straight away after your transplant
• reduce the amount of time spent in hospital, so that you can go home more quickly

We might offer you EVNP:

• if the transplant team is concerned about the chance of the kidney being slow to start working after your transplant
• to allow longer preservation of the kidney

A member of the transplant team will explain why they think that EVNP would be helpful for you and your kidney.

Risks of having EVNP treatment

All medical procedures involve some risk. EVNP might:

• introduce an infection into the kidney
• damage the kidney in some other way

EVNP has been used more than 40 times at Guy’s Hospital. We have not seen any unusual infections, bleeding problems or damage to the kidneys resulting from EVNP.

Other options to EVNP treatment

If you decide not to have EVNP, your kidney transplant will be stored in cold liquid (static cold storage) until your operation.

The transplant surgeon looking after you will tell you if they think that your kidney needs EVNP. Otherwise, they can give you advice on whether static cold storage is an acceptable option for your kidney.

Giving your permission (consent)

We want to involve you in decisions about your care and treatment. If you decide to have EVNP treatment, we will ask you to sign a consent form. This says that you understand what is involved and agree to have the treatment.

If you would like more information about our consent process, please speak to a member of staff caring for you.

After having EVNP treatment

If you have EVNP, the rest of your treatment after the kidney transplant will be normal. You do not need any extra tests or clinic visits. The transplant team will monitor you closely to check for any possible problems that might be due to the EVNP treatment.

Your decision whether to have this new treatment does not affect any other aspect of your care before, during or after the kidney transplant.