Detection of ATP by "in line" 31P magnetic resonance spectroscopy during oxygenated hypothermic pulsatile perfusion of pigs' kidneys.
OBJECTIVE
To demonstrate that adenosine triphosphate (ATP), which provides a valuable biomarker for kidney viability in the context of donation after cardiac death (DCD) transplantation, can be detected by means of (31)P magnetic resonance spectroscopy (MRS) if kidneys are perfused with oxygenated hypothermic pulsatile perfusion (O(2)+HPP).


METHODS
Porcine kidney perfusion was carried out using a home made, MR-compatible HPP-machine. Consequently, kidney perfusion could be performed continuously during magnetic resonance imaging and magnetic resonance spectroscopy recording. (31)P MR spectroscopy consisted of 3-dimensional chemical shift imaging (CSI), which allowed for the detection of ATP level in line. (31)P CSI was performed at 3 tesla in 44 min with a nominal voxel size of 6.1 cc.


RESULTS
(31)P CSI enabled the detection of renal ATP when pO(2) was equal to 100 kPa. With pO(2) of 20 kPa, only phosphomonoester, inorganic phosphate and nicotinamide adenine dinucleotide could be found. Semi-quantitative analysis showed that ATP level was 1.3 mM in normal kidney perfused with pO(2) of 100 kPa.


CONCLUSIONS
This combined technology may constitute a new advance in DCD organ diagnostics prior to transplantation, as it allows direct assessment of ATP concentration, which provides a reliable indicator for organ bioenergetics and viability. In this study, kidneys presenting no warm ischemia were tested in order to establish values in normal organs. The test could be easily integrated into the clinical environment and would not generate any additional delay into the transplantation clinical workflow.
University Hospitals of Geneva, Geneva, Switzerland. francois.lazeyras@unige.ch
Francois
F
Lazeyras
Leo
L
Buhler
Jean-Paul
JP
Vallee
Martin
M
Hergt
Antonio
A
Nastasi
Raphael
R
Ruttimann
Philippe
P
Morel
Jean-Bernard
JB
Buchs
D000255:Adenosine Triphosphate / Q000032:analysis* / Q000737:chemistry; D000818:Animals; D002470:Cell Survival; D003643:Death; D004867:Equipment Design; D007511:Ischemia / Q000473:pathology; D007668:Kidney / Q000378:metabolism*; D016030:Kidney Transplantation / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D009926:Organ Preservation / Q000379:methods; D010100:Oxygen / Q000737:chemistry*; D010759:Phosphorus Isotopes / Q000494:pharmacology*; D011673:Pulsatile Flow; D013552:Swine; D013997:Time Factors
D010759:Phosphorus Isotopes; D000255:Adenosine Triphosphate; D010100:Oxygen