KPJ (kidney protective jacket) Feasibility Study

Patients undergoing kidney transplantation from deceased or living donors including multiorgan transplantation (i.e. simultaneous pancreas and kidney transplants) shall be considered for enrolment. Patients must be aged 18 years and above. First and second transplant patients shall be accepted. The intervention is non-pharmacological. Donor kidneys will undergo preservation by cold storage followed by anatomosis to the recipient temporarily placed within the KPJ (kidney protective jacket). The kidney transplant shall be otherwise performed using standard techniques. Suitable kidneys will be placed in iiPJ after backtable preparation and left in cold storage (CS) until the recipient is ready for implantation. A non-invasive temperature of the exposed kidney at the hilum will be taken using a laser thermometer, directly prior to commencement of vascular anastomoses. When the recipient procedure has progressed to the reimplantation stage the KPJ with the donor kidney insitu will be taken out of the ice and CS into the operative field within the patient for anastomosis. Once renal artery and vein are anastomosed, the KPJ will be rapidly removed and discarded, the temperature of the kidney recorded using a non-invasive laser thermometer directly prior to reperfusion. The KPJ is to be used by the principal investigator and transplant team, all of whom have been trained in the use of the KPJ. The KPJ is a silicone kidney jacket that the kidney is placed into and secured via securing tabs to ensure the kidney does not fall out of the jacket. There is an opening at the top of the jacket through which the important vasculature is accessible. The KPJ is designed to thermally insulate the kidney from the outer environment of the open cavity of the recipient in order to slow down the thermal increase in the kidney's temperature over time. The KPJ is to be for the duration of the transplantation procedure from when the kidney is removed from ice till when anastomoses occurs of the important vasculature. This time period is approximately 30-45 minutes but could extend if surgical complications arise and the transplant takes longer than average (30 minutes at Westmead Hospital, 41 minutes global average). To monitor adherence to the intervention, surgical records shall be taken of: - usage of KPJ through transplant (KPJ used or not used) - time at which KPJ is placed on kidney - time at which KPJ is removed - further comments by surgical staff