A pilot study assessing the feasibility of a short period of normothermic preservation in an experimental model of non heart beating donor kidneys.
BACKGROUND
Restoring metabolism to an organ after hypothermic storage and before transplantation could reverse some of the detrimental effects of ischemic injury. This may be particularly beneficial for kidneys from non-heart-beating (NHBD) donors that sustain significant periods of warm and cold ischemic injury. This pilot study assessed the feasibility of a short period of normothermic preservation (NP) in a porcine autotransplant model.


METHODS
Kidneys were subjected to 30 min of warm ischemia, then preserved by hypothermic machine perfusion (HMP) for 22 h or 20 h HMP followed by 2 h of NP using autologous blood. Kidneys were then re-implanted, a contralateral nephrectomy performed, and renal function measured over 10 d.


RESULTS
Post-transplant, 4/6 animals survived in the NP group compared with 5/6 in the HMP group (P = 1.00). Creatinine levels fell below 250 μmol/L in all four of the surviving animals in the NP group compared with 2/5 in the HMP group (P = 0.608). There was no difference in levels of renal function (peak creatinine, HMP = 1736 ± 866 versus NP = 1553 ± 516 μmol/L; P ≥ 0.990). Levels of lipid peroxidation were significantly lower 60 min post-transplant in the NP group (NP = 477 ± 118.0 versus HMP = 671 ± 99.4 pg/mL; P = 0.026).


CONCLUSIONS
A period of NP at the end of the renal preservation period in NHB kidneys is a feasible method of kidney preservation. NP could prove to be a useful technique to predetermine graft function and allow pre-transplant modification of organs.
Hosgood
Sarah A
SA
Transplant Group, Department of Infection, Immunity and Inflammation, University of Leicester, UK. sarahhosgood@hotmail.com
Barlow
Adam D
AD
Yates
Phillip J
PJ
Snoeijs
Maarten G J
MG
van Heurn
Ernest L W
EL
Nicholson
Michael L
ML
D000818:Animals; D015415:Biomarkers / Q000378:metabolism; D001804:Blood Transfusion, Autologous; D005240:Feasibility Studies; D006085:Graft Survival / Q000502:physiology*; D007668:Kidney / Q000502:physiology*; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D023421:Models, Animal; D009392:Nephrectomy; D009926:Organ Preservation / Q000379:methods*; D018384:Oxidative Stress / Q000502:physiology; D010477:Perfusion / Q000379:methods; D010865:Pilot Projects; D015427:Reperfusion Injury / Q000517:prevention & control*; D034421:Sus scrofa; D013696:Temperature; D014182:Transplantation, Autologous
D015415:Biomarkers