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Am J Transplant. 2017 Apr;17(4):957-969. doi: 10.1111/ajt.14059. Epub 2016 Oct 27.

Continuous Normothermic Ex Vivo Kidney Perfusion Is Superior to Brief Normothermic Perfusion Following Static Cold Storage in Donation After Circulatory Death Pig Kidney Transplantation.

Author information

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 Transplant Surgery, University Medical Center Mainz, Mainz, 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
Developmental & Stem Cell Biology, The Hospital for Sick Children, Toronto, Ontario, Canada.
7
Multi Organ Transplant Program, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
8
Program in Cell Biology, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.

Abstract

Hypothermic preservation is known to cause renal graft injury, especially in donation after circulatory death (DCD) kidney transplantation. We investigated the impact of cold storage (SCS) versus short periods of normothermic ex vivo kidney perfusion (NEVKP) after SCS versus prolonged, continuous NEVKP with near avoidance of SCS on kidney function after transplantation. Following 30 min of warm ischemia, kidneys were removed from 30-kg Yorkshire pigs and preserved for 16 h with (A) 16 h SCS, (B) 15 h SCS + 1 h NEVKP, (C) 8 h SCS + 8 h NEVKP, and (D) 16 h NEVKP. After contralateral kidney resection, grafts were autotransplanted and pigs followed up for 8 days. Perfusate injury markers such as aspartate aminotransferase and lactate dehydrogenase remained low; lactate decreased significantly until end of perfusion in groups C and D (p < 0.001 and p = 0.002). Grafts in group D demonstrated significantly lower serum creatinine peak when compared to all other groups (p < 0.001) and 24-h creatinine clearance at day 3 after surgery was significantly higher (63.4 ± 19.0 mL/min) versus all other groups (p < 0.001). Histological assessment on day 8 demonstrated fewer apoptotic cells in group D (p = 0.008). In conclusion, prolonged, continuous NEVKP provides superior short-term outcomes following DCD kidney transplantation versus SCS or short additional NEVKP following SCS.

KEYWORDS:

animal models: porcine; autotransplantation; basic (laboratory) research/science; donors and donation: donation after circulatory death (DCD); kidney transplantation/nephrology; organ perfusion and preservation; organ transplantation in general; regenerative medicine; tissue injury and repair; translational research/science

PMID:
27647696
DOI:
10.1111/ajt.14059
[Indexed for MEDLINE]
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