Normothermic ex vivo kidney perfusion for graft quality assessment prior to transplantation |
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| Authors: | J Moritz Kaths Mátyás Hamar Juan Echeverri Ivan Linares Peter Urbanellis Jun Yu Cen Sujani Ganesh Luke S Dingwell Paul Yip Rohan John Darius Bagli Istvan Mucsi Anand Ghanekar David Grant Lisa A Robinson Markus Selzner |
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| Institution: | 1. Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada;2. Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada;3. Department of General, Visceral and Transplantation Surgery, Faculty of Medicine, University Hospital Essen, University of Duisburg‐Essen, Essen, Germany;4. Laboratory Medicine & Pathobiology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada;5. Departments of Surgery (Urology) & Physiology, The Hospital for Sick Children, Toronto, Ontario, Canada;6. Multi Organ Transplant Program, Department of Medicine, University of Toronto, Toronto, Ontario, Canada;7. Program in Cell Biology, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada |
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| Abstract: | Normothermic ex vivo kidney perfusion (NEVKP) represents a novel approach for graft preservation and functional improvement in kidney transplantation. We investigated whether NEVKP also allows graft quality assessment before transplantation. Kidneys from 30‐kg pigs were recovered in a model of heart‐beating donation (group A) after 30 minutes (group B) or 60 minutes (group C) (n = 5/group) of warm ischemia. After 8 hours of NEVKP, contralateral kidneys were resected, grafts were autotransplanted, and the pigs were followed for 3 days. After transplantation, renal function measured based on peak serum creatinine differed significantly among groups (P < .05). Throughout NEVKP, intrarenal resistance was lowest in group A and highest in group C (P < .05). intrarenal resistance at the initiation of NEVKP correlated with postoperative renal function (P < .001 at NEVKP hour 1). Markers of acid‐base homeostasis (pH, HCO3–, base excess) differed among groups (P < .05) and correlated with posttransplantation renal function (P < .001 for pH at NEVKP hour 1). Similarly, lactate and aspartate aminotransferase were lowest in noninjured grafts versus donation after circulatory death kidneys (P < .05) and correlated with posttransplantation kidney function (P < .001 for lactate at NEVKP hour 1). In conclusion, assessment of perfusion characteristics and clinically available perfusate biomarkers during NEVKP allows the prediction of posttransplantation graft function. Thus, NEVKP might allow decision‐making regarding whether grafts are suitable for transplantation. |
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| Keywords: | animal models: porcine autotransplantation basic (laboratory) research/science ischemia– reperfusion injury (IRI) kidney transplantation/nephrology organ perfusion and preservation organ transplantation in general regenerative medicine surgical technique translational research/science |
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