K Number
K022391
Device Name
MODIFICATION TO KPS-1, KIDNEY PERFUSION SOLUTIION
Date Cleared
2002-10-21

(90 days)

Product Code
Regulation Number
876.5880
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
KPS-1™, The Kidney Perfusion Solution is intended to be used for flushing and continuous hypothermic machine perfusion of kidneys at the time of their removal from the donor, in preparation for storage, transportation and eventual transplantation into a recipient.
Device Description
KPS-1™, The Kidney Perfusion Solution (UW Machine Perfusion Solution) is a clear, sterile, non-pyrogenic, non-toxic solution for the invitro flushing and temporary continuous perfusion preservation of explanted kidneys. This solution has an approximate calculated osmolarity of 300mOsM, a sodium concentration of 100mEq/L, a potassium concentration of 25mEq/L, and a pH of approximately 7.4 at room temperature. Based upon the sodium/potassium ratio, the composition is thus consistent with that of an extracellular solution. KPS-1™ should be cooled to about 5°C (4°C to 8°C) prior to use and should be used in a perfusion machine that is capable of maintaining temperature within the above specified range. It is recommended that the KPS-1™ be stored between 2 °C and 8 °C. The solution should not be frozen or exposed to excessive heat. KPS-1™, The Kidney Perfusion Solution is suitable for a mean perfusion time of 29 hours +/~ 8 hours. KPS-1™ The Kidney Perfusion Solution shelf-life is 6 months from data of aseptic fill. The stability of the perfusion solution was verified by accelerated aging for 6 months equivalency.
More Information

Not Found

No
The device description focuses solely on the chemical composition and physical properties of a kidney perfusion solution, with no mention of AI/ML capabilities or data processing.

Yes
The device is a solution used for the preservation of explanted kidneys in preparation for transplantation, which directly addresses a health condition (organ preservation for therapy) in a human body.

No

Explanation: The KPS-1™ solution is used for flushing and continuous hypothermic machine perfusion of kidneys for preservation prior to transplantation. It's a preservation solution, not a tool for diagnosing medical conditions.

No

The device description clearly states it is a "solution" and provides chemical composition details, storage requirements, and usage instructions for a liquid used in kidney perfusion. This is a physical substance, not software.

Based on the provided information, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use: The intended use is for flushing and continuous hypothermic machine perfusion of kidneys at the time of their removal from the donor in preparation for storage, transportation, and eventual transplantation. This is a process performed outside of the living body to preserve an organ.
  • Device Description: The description details a solution used for in vitro flushing and temporary continuous perfusion preservation of explanted kidneys. Again, this is an action performed on an organ outside of the body.
  • Lack of Diagnostic Purpose: There is no mention of the device being used to diagnose a disease, condition, or state of health in a patient. It is a preservation solution for an organ.

IVD devices are used to examine specimens derived from the human body (like blood, urine, tissue) to provide information for the diagnosis, monitoring, or treatment of a disease or condition. This device does not fit that description.

N/A

Intended Use / Indications for Use

KPS-1, Kidney Perfusion Solution is intended to be used for in-vitro flushing and temporary continuous hypothermic machine perfusion of kidneys at the time of their removal from the donor, in preparation for storage, transportation and eventual transplantation into a recipient.

Product codes

78 KDN

Device Description

KPS-17M, The Kidney Perfusion Solution (UW Machine Perfusion Solution) is a clear, sterile, non-pyrogenic, non-toxic solution for the invitro flushing and temporary continuous perfusion preservation of explanted kidneys. This solution has an approximate calculated osmolarity of 300mOsM, a sodium concentration of 100mEq/L, a potassium concentration of 25mEq/L, and a pH of approximately 7.4 at room temperature. Based upon the sodium/potassium ratio, the composition is thus consistent with that of an extracellular solution.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

kidneys

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Not Found

Description of the training set, sample size, data source, and annotation protocol

Not Found

Description of the test set, sample size, data source, and annotation protocol

Not Found

Summary of Performance Studies

The stability of the perfusion solution was verified by accelerated aging for 6 months equivalency.

Key Metrics

Not Found

Predicate Device(s)

K013575

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 876.5880 Isolated kidney perfusion and transport system and accessories.

(a)
Identification. An isolated kidney perfusion and transport system and accessories is a device that is used to support a donated or a cadaver kidney and to maintain the organ in a near-normal physiologic state until it is transplanted into a recipient patient. This generic type of device may include tubing, catheters, connectors, an ice storage or freezing container with or without bag or preservatives, pulsatile or nonpulsatile hypothermic isolated organ perfusion apparatus with or without oxygenator, and disposable perfusion set.(b)
Classification. Class II (performance standards).

0

022391 1 of 3

OCT 21 2002

510(k) SUMMARY

Organ Recovery Systems, Inc. KPS-1, Kidney Perfusion Solution

1. SUBMITTER INFORMATION

  • A. Organ Recovery Systems, Inc., 701 E. Bay St., Suite 433 MSC 1119 Port City Center Charleston, SC 29403
    Federal Identification Number: 36-4256620

  • B. Official Correspondent:
    Stanley J. Harris, Director, Regulatory and Clinical Affairs

Phone: (843) 853-6756 ex. 29 (843) 722-6657 Fax:

2. DEVICE IDENTIFICATION

| A. Classification Name: | Isolated kidney perfusion and transport system and
accessories (21 CFR 876.5880) |
|-------------------------|-------------------------------------------------------------------------------------|
| B. Classification: | Class II, Gastroenterology/Urology Panel |
| C. Common/Usual Name: | Cold Storage Solution |
| D. Proprietary Name: | KPS-1, Kidney Perfusion Solution |

3. PREDICATE DEVICE

KPS-17M, Kidney Perfusion Solution (K013575) (University of Wisconsin Machine Perfusion Solution Formulation)

Indications for Use: KPS-1, Kidney Perfusion Solution is intended to be used for in-vitro flushing and temporary continuous hypothermic machine perfusion of kidneys at the time of their removal from the donor, in preparation for storage, transportation and eventual transplantation into a recipient.

1

Device Description: KPS-17M, The Kidney Perfusion Solution (UW Machine Perfusion Solution) is a clear, sterile, non-pyrogenic, non-toxic solution for the invitro flushing and temporary continuous perfusion preservation of explanted kidneys. This solution has an approximate calculated osmolarity of 300mOsM, a sodium concentration of 100mEq/L, a potassium concentration of 25mEq/L, and a pH of approximately 7.4 at room temperature. Based upon the sodium/potassium ratio, the composition is thus consistent with that of an extracellular solution.

4. DESCRIPTION OF DEVICE

KPS-17M, Kidney Perfusion Solution (University of Wisconsin Machine Perfusion Solution Formulation)

Indications for Use: KPS-1, Kidney Perfusion Solution is intended to be used for in-vitro flushing and temporary continuous bypothermic machine perfusion of kidneys at the time of their removal from the donor, in preparation for storage, transportation and eventual transplantation into a recipient.

Device Description: KPS-1™, The Kidney Perfusion Solution (UW Machine Perfusion Solution) is a clear, sterile, non-pyrogenic, non-toxic solution for the invitro flushing and temporary continuous perfusion preservation of explanted kidneys. This solution has an approximate calculated osmolarity of 300m()sM, a sodium concentration of 100mEq/L, a potassium concentration of 25mEq/L, and a pH of approximately 7.4 at room temperature. Based upon the sodium/potassium ratio, the composition is thus consistent with that of an extracellular solution.

KPS-1™ should be cooled to about 5°C (4°C to 8°C) prior to use and should be used in a perfusion machine that is capable of maintaining temperature within the above specified range.

It is recommended that the KPS-1™ be stored between 2 °C and 8 °C. The solution should not be frozen or exposed to excessive heat.

KPS-1™, The Kidney Perfusion Solution is suitable for a mean perfusion time of 29 hours +/~ 8 hours.

KPS-1™ The Kidney Perfusion Solution shelf-life is 6 months from data of aseptic fill. The stability of the perfusion solution was verified by accelerated aging for 6 months equivalency.

2

SUBSTANTIAL EQUIVALENCE

  • A. Indications for Use: The indications for use remain unchanged for the modifications requested within this submission.
  • B. Technological Characteristics: Unchanged from Original Submission.

5. CONCLUSION

KPS-1™, The Kidney Perfusion Solution has the same intended use as the original submission (K013575) and the data presented in this submission demonstrates that the device modifications to KPS-1™, The Kidney Perfusion Solution is substantially equivalent to original submission (K013575).

3

DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/3/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a stylized eagle with three stripes extending from its head, representing the department's commitment to health, human services, and well-being. The words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" are arranged in a circular pattern around the eagle.

Public Health Service

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

OCT 2 1 2002

Mr. Stanley J. Harris

Director, Regulatory and Clinical Affairs Organ Recovery Systems, Inc. 701 East Bay Street, Suite 433 Port City Center, MSC 1119 CHARLESTON SC 29403

Re: K022391

Trade/Device Name: KPS-1 ™ The Kidney Perfusion Solution . Regulation Number: 21 CFR §876.5880 Regulation Name: Isolated kidney perfusion and transport system and accessories Regulatory Class: II Product Code: 78 KDN Dated: September 23, 2002 Received: September 24, 2002

Dear Mr. Harris:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food, Drug, and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); good manufacturing practice requirements as set forth in the quality systems (OS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (sections 531-542 of the Act); 21 CFR 1000-1050.

4

This letter will allow you to begin marketing your device as described in your 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed predicate device results in a classification for your device and thus, permits your device to proceed to the market.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Office of Compliance at one of the following numbers, based on the regulation number at the top of this letter:

8xx.1xxx(301) 594-4591
876.2xxx, 3xxx, 4xxx, 5xxx(301) 594-4616
884.2xxx, 3xxx, 4xxx, 5xxx, 6xxx(301) 594-4616
892.2xxx, 3xxx, 4xxx, 5xxx(301) 594-4654
Other(301) 594-4692

Additionally, for questions on the promotion and advertising of your device, please contact the Office of Compliance at (301) 594-4639. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR Part 807.97). Other general information on your responsibilities under the Act may be obtained from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number (800) 638-2041 or (301) 443-6597 or at its Internet address http://www.fda.gov/cdrh/dsma/dsmamain.html.

Sincerely yours,

Nancy C. Brogdon

Nancy C. Brogdon Director, Division of Reproductive, Abdominal, and Radiological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

5

KPS-1™, The Kidney Perfusion Solution Special 510(k): Device Modifications July 16, 2002 Page 8 of 86

5. INDICATIONS FOR USE STATEMENT

.

Device Name: KPS-1™ The Kidney Perfusion Solution

Indications for Use:

KPS-1™, The Kidney Perfusion Solution is intended to be used for flushing and continuous hypothermic machine perfusion of kidneys at the time of their removal from the donor, in preparation for storage, transportation and eventual transplantation into a recipient.

Prescription Use
(Per 21 CFR 801.109)

Daniel A. Symm
(Division Sign-Off)

Division of Reproductive, Abdomi and Radiological Devices 510(k) Number