title: Hypothermic reconditioning of porcine kidney grafts by short-term preimplantation machine perfusion.
abstract: BACKGROUND
  Clinical trial data suggest that continuous hypothermic machine perfusion (HMP) during the entire preservation period reduces the incidence of delayed graft function and improves graft survival. This study evaluates whether short-term MP after cold storage (CS) is also effective.
  
  
  METHODS
  Kidney function after cold preservation (4°C, 21 hr) and transplantation was studied in an autotransplant model using Landrace pigs (25-30 kg; n=5 per group) with 1 week follow-up. Preservation was performed by conventional CS or HMP with a modified Lifeport Kidney Transporter either continuously during the entire preservation period or only for 2 hr of hypothermic reconditioning (HR) subsequent to conventional CS.
  
  
  RESULTS
  HMP and HR similarly improved cortical microcirculation and significantly reduced maximal serum creatinine levels and recovery of creatinine clearance to normal values compared with CS. Fractional excretion of Na+ was unaltered after HMP and HR but significantly increased until postoperative day 5 on CS. On a molecular level, HR reduced innate immunoreactivity (toll-like receptor 4 expression and high mobility group protein B1 [HMGB-1] release) and normalized antiinflammatory tissue expression of von Kruppel-like Factor-2.
  
  
  CONCLUSIONS
  Short-term reconditioning after CS proves to be as effective as continuous MP during the whole storage time. Because of its logistical convenience, the concept of an a posteriori treatment recommends itself to be evaluated in clinical trials.
authors.affiliation: Department for General, Visceral and Transplantation Surgery, University Hospital of Essen, Essen, Germany.
authors.forename: Anja
authors.initials: A
authors.lastname: Gallinat
authors.forename: Andreas
authors.initials: A
authors.lastname: Paul
authors.forename: Patrik
authors.initials: P
authors.lastname: Efferz
authors.forename: Bastian
authors.initials: B
authors.lastname: Lüer
authors.forename: Gernot
authors.initials: G
authors.lastname: Kaiser
authors.forename: Jeremias
authors.initials: J
authors.lastname: Wohlschlaeger
authors.forename: Jürgen
authors.initials: J
authors.lastname: Treckmann
authors.forename: Thomas
authors.initials: T
authors.lastname: Minor
mesh_terms: D000818:Animals; D006085:Graft Survival; D024243:HMGB1 Protein / Q000096:biosynthesis / Q000276:immunology; D007036:Hypothermia, Induced / Q000379:methods; D007668:Kidney / Q000276:immunology; D016030:Kidney Transplantation / Q000276:immunology / Q000379:methods*; D051741:Kruppel-Like Transcription Factors / Q000096:biosynthesis / Q000276:immunology; D009926:Organ Preservation; D019188:Organ Preservation Solutions / Q000494:pharmacology*; D010477:Perfusion / Q000379:methods*; D012964:Sodium / Q000652:urine; D013552:Swine / Q000276:immunology; D051197:Toll-Like Receptor 4 / Q000096:biosynthesis / Q000276:immunology
chemical_list: D024243:HMGB1 Protein; D051741:Kruppel-Like Transcription Factors; D019188:Organ Preservation Solutions; D051197:Toll-Like Receptor 4; D012964:Sodium