SYSTEMATIC REVIEW article
Front. Med. Technol.
Sec. Diagnostic and Therapeutic Devices
Volume 7 - 2025 | doi: 10.3389/fmedt.2025.1600784
Cooling devices used to avoid warm ischemia time injury during kidney transplantation. Systematic review and meta-analysis
Provisionally accepted
Marco Alejandro Arizmendi-Villarreal1
Alejandro Diaz Gonzalez- Colmenero1
Jorge Alberto Cantu-Hernandez1
Javier Sánchez-Maldonado2Gerardo Enrique Muñoz-Maldonado1Edelmiro Pérez Rodríguez2Homero Arturo Zapata-Chavira2Rene Rodríguez-Gutiérrez3,4Francisco Javier Reyna-Sepúlveda2*- 1Department of General Surgery, Hospital Universitario “Dr. José Eleuterio González”, U.A.N.L., Monterrey, Mexico
- 2Department of Transplantation, Hospital Universitario “Dr. José Eleuterio González”, U.A.N.L, Monterrey, Mexico
- 3Department of Endocrinology, Dr José Eleuterio Gonzalez University Hospital, Monterrey, México, Mexico
- 4Plataforma INVEST Medicina UANL – KER Unit Mayo Clinic (KER Unit México), U.A.N.L, Monterrey, Mexico
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Warm ischemia during kidney transplantation contributes to graft dysfunction. External cooling devices have been developed to preserve graft during anastomosis, with promising results in experimental models. A systematic review and meta-analysis were conducted to evaluate the effectiveness of renal cooling devices. The protocol was registered in PROSPERO (CRD42023409480). A comprehensive search of seven databases was performed from inception to January 6, 2023. Eligible studies were randomized, prospective, and included a control group. Four studies met the inclusion criteria. All studies reported significantly lower reperfusion temperatures in kidneys treated with cooling devices compared to controls. Histological graft injury, showed no statistically significant difference (SMD -0.95; 95% CI -10.74 to 8.83). However, post-transplant urinary output was significantly higher in the cooling device groups (SMD 0.49; 95% CI 0.10 to 0.88). The overall risk of bias across included studies was high. Cooling devices effectively lower graft temperature and may improve early functional outcomes. However, evidence of histological benefit remains inconclusive. Further clinical trials are needed to confirm efficacy and standardize device implementation in human transplantation.
Keywords: Ischemia-Reperfusión Injury1, Cold Ischemia Time2, Warm Ischemia Time3, kidney transplantation4, Organ Preservation5
Received: 26 Mar 2025; Accepted: 24 Jul 2025.
Copyright: © 2025 Arizmendi-Villarreal, Diaz Gonzalez- Colmenero, Cantu-Hernandez, Sánchez-Maldonado, Muñoz-Maldonado, Pérez Rodríguez, Zapata-Chavira, Rodríguez-Gutiérrez and Reyna-Sepúlveda. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Francisco Javier Reyna-Sepúlveda, Department of Transplantation, Hospital Universitario “Dr. José Eleuterio González”, U.A.N.L, Monterrey, Mexico
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