{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T04:45:30Z","timestamp":1785818730896,"version":"3.56.0"},"reference-count":19,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,8,2]],"date-time":"2026-08-02T00:00:00Z","timestamp":1785628800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"PSI","award":["#23-25"],"award-info":[{"award-number":["#23-25"]}]},{"DOI":"10.13039\/100010564","name":"AMOSO","doi-asserted-by":"crossref","award":["INN24-015"],"award-info":[{"award-number":["INN24-015"]}],"id":[{"id":"10.13039\/100010564","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: Preservation of renal hypothermia during vascular anastomosis remains a critical yet insufficiently optimized aspect of kidney transplantation. Rewarming during the second warm ischemic period increases metabolic activity and may exacerbate ischemia\u2013reperfusion injury. Maintaining graft temperatures below the 15\u201318 \u00b0C metabolic threshold during implantation is associated with improved graft preservation, yet more than 80% of grafts exceed this threshold within 20 min under standard conditions. This study evaluated the thermal performance of a novel cooling adjunct, the Ice Pillow, in limiting renal rewarming under simulated ex vivo transplant conditions. Methods: Twelve human renal allografts (six donor pairs) were studied in a controlled laboratory setting following hypothermic machine perfusion. Within each donor pair, kidneys were randomly assigned to the Ice Pillow group or the Control group. Core temperature was measured using an intra-pelvic thermocouple probe, while surface temperature was assessed with a handheld infrared thermometer. Kidneys in the Ice Pillow group were positioned on a thin gauze pouch filled with ice slush. Control kidneys were rewarmed in a simulated body cavity at 30\u201332 \u00b0C. Temperature recordings were obtained at one-minute intervals over 40 min. Rewarming slopes were compared using donor-paired analysis. Longitudinal temperature trajectories were analyzed using a linear mixed-effects model accounting for repeated measurements within kidneys. Agreement between core and surface measurements was evaluated using Bland\u2013Altman analysis. Results: The Ice Pillow reduced the rate of renal rewarming by 56.4% compared with donor-paired controls (0.261 \u00b1 0.057 \u00b0C\/min vs. 0.599 \u00b1 0.066 \u00b0C\/min; mean donor-paired difference 0.338 \u00b0C\/min; 95% CI, 0.237\u20130.440; t(5) = 8.56, p &lt; 0.001). Linear mixed-effects modelling demonstrated progressive thermal separation between groups, with Control kidneys estimated to be 4.28 \u00b0C warmer at 10 min (95% CI, 3.35\u20135.22; p &lt; 0.001) and 10.44 \u00b0C warmer at 40 min (95% CI, 7.88\u201312.99; p &lt; 0.001). Bland\u2013Altman analysis of core\u2013surface agreement demonstrated a mean bias of \u22120.51 \u00b0C with 95% limits of agreement of \u22126.46 \u00b0C to 5.43 \u00b0C, indicating that surface thermometry followed the general direction of core temperature change but demonstrated wide limits of agreement, indicating the two methods are not interchangeable. Conclusions: In this ex vivo model, the Ice Pillow substantially attenuated renal rewarming compared with unassisted controls. Whether this thermal effect translates into improved graft function requires prospective clinical evaluation.<\/jats:p>","DOI":"10.3390\/jcm15156001","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T11:50:21Z","timestamp":1785757821000},"page":"6001","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Novel Ice Pillow Cooling Technique Reduces Renal Rewarming During Simulated Vascular Anastomosis: An Ex Vivo Study Using Human Renal Allografts"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9155-3262","authenticated-orcid":false,"given":"Martin","family":"Igbokwe","sequence":"first","affiliation":[{"name":"Multi-Organ Transplant Program, London Health Sciences Centre, London, ON N6A 5A5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saeed","family":"Farzamfar","sequence":"additional","affiliation":[{"name":"Matthew Mailing Center for Translational Transplant Studies, London Health Sciences Centre, London, ON N6A 5A5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-0844-961X","authenticated-orcid":false,"given":"Khushi","family":"Vyas","sequence":"additional","affiliation":[{"name":"Schulich School of Medicine and Dentistry, London, ON N6A 5A5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1936-845X","authenticated-orcid":false,"given":"Cory","family":"Byrne","sequence":"additional","affiliation":[{"name":"Schulich School of Medicine and Dentistry, London, ON N6A 5A5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Larry","family":"Jiang","sequence":"additional","affiliation":[{"name":"Matthew Mailing Center for Translational Transplant Studies, London Health Sciences Centre, London, ON N6A 5A5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Bozaci","sequence":"additional","affiliation":[{"name":"Multi-Organ Transplant Program, London Health Sciences Centre, London, ON N6A 5A5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8305-0876","authenticated-orcid":false,"given":"Alp","family":"Sener","sequence":"additional","affiliation":[{"name":"Multi-Organ Transplant Program, London Health Sciences Centre, London, ON N6A 5A5, Canada"},{"name":"Matthew Mailing Center for Translational Transplant Studies, London Health Sciences Centre, London, ON N6A 5A5, Canada"},{"name":"Schulich School of Medicine and Dentistry, London, ON N6A 5A5, Canada"},{"name":"Department of Surgery, Division of Urology, London Health Sciences Centre, University of Western Ontario, London, ON N6A 5A5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick P.","family":"Luke","sequence":"additional","affiliation":[{"name":"Multi-Organ Transplant Program, London Health Sciences Centre, London, ON N6A 5A5, Canada"},{"name":"Matthew Mailing Center for Translational Transplant Studies, London Health Sciences Centre, London, ON N6A 5A5, Canada"},{"name":"Schulich School of Medicine and Dentistry, London, ON N6A 5A5, Canada"},{"name":"Department of Surgery, Division of Urology, London Health Sciences Centre, University of Western Ontario, London, ON N6A 5A5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Nieuwenhuijs-Moeke, G.J., Pischke, S.E., Berger, S.P., Sanders, J.S.F., Pol, R.A., Struys, M.M.R.F., Ploeg, R.J., and Leuvenink, H.G.D. (2020). Ischemia and reperfusion injury in kidney transplantation: Relevant mechanisms in injury and repair. J. Clin. Med., 9.","DOI":"10.3390\/jcm9010253"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"482438","DOI":"10.1155\/2014\/482438","article-title":"Biological pathways and potential targets for prevention and therapy of chronic allograft nephropathy","volume":"2014","author":"Shrestha","year":"2014","journal-title":"BioMed Res. Int."},{"key":"ref_3","first-page":"9617087","article-title":"Pharmacological protection of kidney grafts from cold perfusion-induced injury","volume":"2019","author":"Franczak","year":"2019","journal-title":"BioMed Res. Int."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"750602","DOI":"10.1155\/2014\/750602","article-title":"The interplay between inflammation and fibrosis in kidney transplantation","volume":"2014","author":"Torres","year":"2014","journal-title":"BioMed Res. Int."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"7037363","DOI":"10.1155\/mi\/7037363","article-title":"XBP1s-Orchestrated Soluble Mediators: Participants of Oxidative Stress in Renal Ischemia-Reperfusion Injury Following Donation After Circulatory Death","volume":"2026","author":"Zhang","year":"2026","journal-title":"Mediat. Inflamm."},{"key":"ref_6","first-page":"6305439","article-title":"Innate immune response in kidney ischemia\/reperfusion injury: Potential target for therapy","volume":"2017","author":"Stajic","year":"2017","journal-title":"J. Immunol. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"4143","DOI":"10.1097\/JS9.0000000000001385","article-title":"Continuous renal surface cooling technique (CSCT) in robotic-assisted kidney transplantation: Technique and outcomes from a high-volume center: A prospective cohort study","volume":"110","author":"Zhang","year":"2024","journal-title":"Int. J. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"3144","DOI":"10.1016\/j.transproceed.2018.09.003","article-title":"Techniques to ameliorate the impact of second warm ischemic time on kidney transplantation outcomes","volume":"50","author":"Hameed","year":"2018","journal-title":"Transplant. Proc."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1111\/tri.12892","article-title":"Kidney temperature course during living organ procurement and transplantation","volume":"30","author":"Kuipers","year":"2017","journal-title":"Transpl. Int."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e900","DOI":"10.1097\/01.JU.0001110028.22652.53.37","article-title":"Comparison of controlled versus standard rewarming protocols on renal allograft temperature dynamics during anastomosis and reperfusion","volume":"213","author":"Igbokwe","year":"2025","journal-title":"J. Urol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1111\/ajt.14399","article-title":"Intra-abdominal cooling system limits ischemia-reperfusion injury during robot-assisted renal transplantation","volume":"18","author":"Meier","year":"2018","journal-title":"Am. J. Transplant."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1007\/s00345-023-04328-9","article-title":"Systematic review of techniques and devices used to avoid warm ischemia time injury during kidney transplantation","volume":"41","author":"Andras","year":"2023","journal-title":"World J. Urol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"752","DOI":"10.1016\/j.transproceed.2023.03.004","article-title":"Effectiveness of thermal barrier bag for prolonged vascular anastomosis in kidney transplantation","volume":"55","author":"Ide","year":"2023","journal-title":"Transplant. Proc."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"36118","DOI":"10.1038\/srep36118","article-title":"The influence of warm ischemia elimination on kidney injury during transplantation: Clinical and molecular study","volume":"6","author":"Chudoba","year":"2016","journal-title":"Sci. Rep."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1016\/S0140-6736(02)07749-8","article-title":"Liver and kidney preservation by perfusion","volume":"359","author":"Imber","year":"2002","journal-title":"Lancet"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Igbokwe, M., Wang, J., Byrne, C., Vyas, K.A., Richard-Mohammed, M., Alfaifi, A., Sener, A., and Luke, P.P. (Transplant. Proc., 2026). Correlating infrared surface thermometry with core temperature assessments in simulated cooling and rewarming of porcine kidneys, Transplant. Proc., in press.","DOI":"10.1016\/j.transproceed.2026.05.019"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1016\/j.eururo.2021.05.026","article-title":"Step-by-step Development of a Cold Ischemia Device for Open and Robotic-assisted Renal Transplantation","volume":"80","author":"Territo","year":"2021","journal-title":"Eur. Urol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"957054","DOI":"10.1155\/2013\/957054","article-title":"Oxidative stress and antioxidant activity in hypothermia and rewarming: Can RONS modulate the beneficial effects of therapeutic hypothermia?","volume":"2013","author":"Alva","year":"2013","journal-title":"Oxidative Med. Cell. Longev."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1016\/j.kint.2015.09.002","article-title":"Prolonged warm ischemia time is associated with graft failure and mortality after kidney transplantation","volume":"89","author":"Tennankore","year":"2016","journal-title":"Kidney Int."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/15\/6001\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T04:15:41Z","timestamp":1785816941000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/15\/6001"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,2]]},"references-count":19,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["jcm15156001"],"URL":"https:\/\/doi.org\/10.3390\/jcm15156001","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,2]]}}}