Minimising cold ischaemic injury in an experimental model of kidney transplantation.
BACKGROUND
Cold ischaemic (CI) injury is associated with reduced renal graft function and survival. However, there is little evidence on the benefits of reducing CI injury within a 24 h period in donation after cardiac death (DCD) kidney transplantation.


METHODS
Porcine kidneys subjected to 10-min warm ischaemia were retrieved and flushed with hyperosmolar citrate (HOC) preservation solution at 4 °C. They were stored on ice for periods of 2, 6, 18 or 24 h (n = 6). Renal function and injury were assessed during 3 h of ex-vivo reperfusion with oxygenated autologous blood.


RESULTS
Area under the curve (AUC) serum creatinine (Cr) levels were significantly higher in the 18- and 24-h groups and creatinine clearance (CrCl) lower compared to the 2-h group (P = 0·001, 0·003). Urinary biomarkers of ischaemic damage (Endothelin-1, Total nitric oxide) and renal and tubular cell function significantly correlated with the duration of CI time (r = 0·726, 0·642; P ≤ 0·001).


CONCLUSIONS
This study demonstrated the progressive effects of CI injury in DCD porcine kidneys over a 24 h hypothermic storage period. This highlights the need to minimise the cold storage period to improve graft function in DCD kidney transplantation.
Department of Infection, Immunity and Inflammation, Transplant Group, University of Leicester, Leicester General Hospital, LE5 4PW, UK. sarahhosgood@hotmail.com
Sarah A
SA
Hosgood
Atul
A
Bagul
Michael L
ML
Nicholson
D000818:Animals; D019540:Area Under Curve; D050377:Cold Ischemia / Q000009:adverse effects* / Q000379:methods*; D003080:Cold Temperature / Q000009:adverse effects; D006801:Humans; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D023421:Models, Animal; D009926:Organ Preservation / Q000379:methods*; D019188:Organ Preservation Solutions; D015427:Reperfusion Injury / Q000517:prevention & control*; D013552:Swine; D013997:Time Factors; D020858:Tissue and Organ Harvesting / Q000379:methods*
D019188:Organ Preservation Solutions