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Effect of aspirin or resistant starch on colorectal neoplasia in the Lynch syndrome.

The Authors Reply: Our international clinical study compared machine perfusion with cold storage of kidneys obtained from donors after brain death or from donors after cardiocirculatory death (in Maastricht category III). The organs studied in our trial are the most common deceased-donor kidneys. We very much agree with Ray and colleagues that machine perfusion is also likely to be useful for renal allografts obtained from donors after cardiocirculatory death who are in Maastricht categories I, II, or IV, because their organs have sustained more severe ischemic injury. The study by Ray et al. presents promising results. Our group has found that perfusion settings are critical for maintaining the viability of the vascular endothelium.1 Currently, in our prospective data set, we are investigating whether vascular resistance and various perfusate biomarkers during machine perfusion have independent predictive value for determining which kidneys have a high risk of complications or failure after transplantation. We speculate that with the use of such data, machine perfusion might become an additional diagnostic tool for selecting kidneys that are sufficiently viable for transplantation but that might otherwise have been discarded.2 In addition, normothermic machine perfusion and normothermic recirculation are interesting new techniques that may improve the viability of marginal donor kidneys.3-5