Evaluation of pulsatile perfusion machine RM3 for kidney preservation in a swine model of renal autotransplantation.
OBJECTIVE
Transplantations of kidneys from non-heart-beating donors (NHBD) are intended to increase the donor pool by 20% to 30%. Nevertheless the rate of primary nonfunction and delayed graft function is generally higher among this group of donors. The goal of this study was to assess whether kidney preservation by a pulsatile perfusion machine was able to limit the renal lesions due to ischemia reperfusion injuries as compared with static incubation. We have used a model of an autotransplanted kidney exposed to controlled warm ischemia in the pig to mimic the clinical conditions of NHBD.


METHODS
Left kidneys from 11 large white pigs aged 4 weeks were harvested after vascular clamping of the renal vessels for 1 hour. Kidneys were preserved for 22 hours. Two groups were studied: the MPS static group (static incubation with Belzer MPS; n = 6) versus the MPS RM group (renal perfusion with Belzer MPS; n = 5). Kidneys were then autotransplanted into pigs after a right nephrectomy. The primary end point was animal survival rate at 1 month. Secondary endpoints were evolution of the plasma creatinine values, proteinuria, tubular sodium reabsorption, and histological features at 1 month.


RESULTS
For all biological parameters, the differences between the perfusion and the static incubation groups were significant, except creatinine, with favorable effects for the perfusion machine group. The histological data at 1 month showed recovery of the normal kidney architecture in the MPS RM group.


CONCLUSIONS
In our pig experimental model that reproduced the clinical conditions of a NHBD, we demonstrated better kidney preservation when the pulsatile perfusion machine was used as compared with static conservation.
Service de Chirurgie Urologique et de la Transplantation, Hôpital E Herriot HCL, Université Lyon, Lyon, France.
R
R
Codas
L
L
Badet
M
M
Eugene
S
S
Giraud
R
R
Thuiller
T
T
Hauet
D000818:Animals; D003404:Creatinine / Q000097:blood; D006085:Graft Survival; D007668:Kidney / Q000502:physiology*; D016030:Kidney Transplantation / Q000379:methods / Q000502:physiology*; D007684:Kidney Tubules / Q000502:physiology; D009926:Organ Preservation / Q000295:instrumentation / Q000379:methods*; D010477:Perfusion / Q000295:instrumentation / Q000379:methods; D011507:Proteinuria; D012964:Sodium / Q000378:metabolism; D013552:Swine; D014182:Transplantation, Autologous / Q000379:methods / Q000502:physiology
D012964:Sodium; D003404:Creatinine