title: Benefits of active oxygenation during hypothermic machine perfusion of kidneys in a preclinical model of deceased after cardiac death donors.
abstract: BACKGROUND
  Deceased after cardiac death donors (DCDs) represent a valuable source of organs; however, preventing poor outcome is difficult, even with the use of machine perfusion (MP). It is of paramount importance to improve this method. We proposed to evaluate the benefits of active oxygenation during kidney graft hypothermic MP using a novel perfusion machine: Kidney Assist (KA).
  
  
  METHODS
  We used a pig model of DCD transplantation in Large White pigs. Cold preservation was performed by conventional non-oxygenated MP (KAnoO2) or oxygenated MP (KA).
  
  
  RESULTS
  In the first 2 wk post-transplant, KA grafts displayed a lower serum creatinine peak and a faster return to normal levels compared with KAnoO2 animals, translating into a smaller area under the curve. Urinary neutrophil gelatinase-associated lipocalin levels and serum aspartate amino transferase levels were lower in KA animals compared with the non-oxygenated group. These correlated with better chronic function. Longer follow-up of the animals (3 mo) permitted evaluation of chronic outcome lesions. Interstitial fibrosis was reduced in the KA group, and these kidneys also displayed significantly lower levels of vimentin staining. Further histologic investigation also showed a trend toward decreased chronic inflammation in kidneys preserved with oxygen.
  
  
  CONCLUSIONS
  This new MP system is efficient in preserving DCD kidneys, greatly enhancing the capacity of the graft to withstand preservation stress and improving outcome. Oxygen delivery during preservation is thus valuable for highly damaged organs and offers an important therapeutic tool for transplant teams faced with decreased quality of donor organs.
authors.affiliation: INSERM U1082, Poitiers, France; Université Poitiers, Poitiers, France; CHU Poitiers, Pole UBM, Service de Biochimie, Poitiers, France; FLIRT: Fédération pour L'étude de l'Ischémie Reperfusion en Transplantation, Poitiers, France.
authors.forename: Raphaël
authors.initials: R
authors.lastname: Thuillier
authors.forename: Geraldine
authors.initials: G
authors.lastname: Allain
authors.forename: Olivier
authors.initials: O
authors.lastname: Celhay
authors.forename: William
authors.initials: W
authors.lastname: Hebrard
authors.forename: Benoit
authors.initials: B
authors.lastname: Barrou
authors.forename: Lionel
authors.initials: L
authors.lastname: Badet
authors.forename: Henri
authors.initials: H
authors.lastname: Leuvenink
authors.forename: Thierry
authors.initials: T
authors.lastname: Hauet
mesh_terms: D000818:Animals; D001219:Aspartate Aminotransferases / Q000097:blood; D003404:Creatinine / Q000097:blood; D003643:Death; D007036:Hypothermia, Induced / Q000379:methods*; D007668:Kidney / Q000473:pathology / Q000502:physiology*; D054834:Lipocalins / Q000652:urine; D008297:Male; D023421:Models, Animal; D010477:Perfusion / Q000379:methods; D017382:Reactive Oxygen Species / Q000008:administration & dosage*; D020127:Recovery of Function / Q000502:physiology; D013552:Swine; D014019:Tissue Donors; D014746:Vimentin / Q000378:metabolism
chemical_list: D054834:Lipocalins; D017382:Reactive Oxygen Species; D014746:Vimentin; D003404:Creatinine; D001219:Aspartate Aminotransferases
keywords: DCD; Kidney transplantation; Machine perfusion; Marginal donors; Oxygen; Preclinical