Hypothermic reconditioning after cold storage improves postischemic graft function in isolated porcine kidneys.
Delayed graft function still represents a major complication in clinical kidney transplantation. Here we tested the possibility to improve functional outcome of cold stored kidneys a posteriori by short-term hypothermic machine perfusion immediately prior to reperfusion. A total of 18 kidneys from female German Landrace pigs was flushed with Histidine-Tryptophan-Ketoglutarate solution and cold-stored for 18 h (control). Some grafts were subsequently subjected to 90 min of hypothermic reconditioning by hypothermic machine perfusion with (HR+O(2)) or without (HR-O(2)) oxygenation of the perfusate. Early graft function of all kidneys was assessed thereafter by warm reperfusion in vitro (n = 6, respectively). Renal function upon reperfusion was significantly enhanced by HR+O(2) with more than threefold increase in renal clearances of creatinine and urea. HR+O(2) also led to significantly higher urinary flow rates and abrogated the activation of caspase 3. By contrast, HR-O(2) was far less effective and only resulted in minor differences compared to control. It is derived from the present data that initial graft function can be significantly improved by 2 h of oxygenated machine perfusion after arrival of the preserved organ in the transplantation clinic.
Koetting
Martina
M
Department for General, Visceral and Transplantation Surgery, University Hospital of 1 Essen, Essen, Germany.
Frotscher
Carolin
C
Minor
Thomas
T
D000818:Animals; D053148:Caspase 3 / Q000378:metabolism; D003080:Cold Temperature; D005260:Female; D006085:Graft Survival; D007036:Hypothermia, Induced / Q000379:methods*; D007511:Ischemia / Q000473:pathology*; D007668:Kidney / Q000473:pathology*; D016030:Kidney Transplantation / Q000379:methods*; D009926:Organ Preservation / Q000379:methods*; D010100:Oxygen / Q000737:chemistry / Q000378:metabolism; D010477:Perfusion; D013552:Swine; D016896:Treatment Outcome
D053148:Caspase 3; D010100:Oxygen