title: Preservation of kidneys by machine perfusion influences gene expression and may limit ischemia/reperfusion injury.
abstract: BACKGROUND
  Machine perfusion improves graft survival. Histopathologic analysis reveals a lower incidence of chronic rejection and interstitial fibrosis in kidneys preserved with machine perfusion. Ischemic/reperfusion injury may help to explain these findings.
  
  
  OBJECTIVE
  To assess the activation of genes correlated with ischemic/reperfusion injury in kidneys preserved under different conditions before transplant.
  
  
  METHODS
  Between 2005 and 2006, 69 kidney biopsy specimens were collected and patients were followed up for 5 years after that.Intervention-Before transplant, kidneys were preserved with machine perfusion or cold storage. Donors from the machine perfusion and cold storage groups did not differ with regard to age, sex, or hemodynamic status. Recipients were divided into 5 groups: expanded criteria donor-machine perfusion (n = 16), standard criteria donor-machine perfusion (n = 10), expanded criteria donor-cold storage (n = 9), and standard criteria donor-cold storage (n = 27); 7 kidneys were retrieved from living related donors.
  
  
  METHODS
  Biopsies were done 30 minutes after reperfusion. Interleukin-1β, vascular endothelial growth factor, heme oxygenase-1, and hypoxia-inducible factor-1 gene expression levels were analyzed.
  
  
  RESULTS
  Mean expression levels of hypoxia-inducible factor-1α were significantly higher in the cold storage groups, and lower in the machine perfusion and living-related donor groups. Five-year graft survival was significantly (P< .05) lower in the expanded criteria donor-cold storage group (66%) than in the standard criteria donor-machine perfusion group (90%). Machine perfusion influences gene expression related to hypoxia during reperfusion and may improve the long-term results of kidney transplant.
authors.affiliation: Warsaw Medical University, Poland.
authors.forename: Michal
authors.initials: M
authors.lastname: Wszola
authors.affiliation: Warsaw Medical University, Poland.
authors.forename: Artur
authors.initials: A
authors.lastname: Kwiatkowski
authors.affiliation: Warsaw Medical University, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Domagala
authors.affiliation: Warsaw Medical University, Poland.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Wirkowska
authors.affiliation: Warsaw Medical University, Poland.
authors.forename: Monika
authors.initials: M
authors.lastname: Bieniasz
authors.affiliation: Warsaw Medical University, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Diuwe
authors.affiliation: Warsaw Medical University, Poland.
authors.forename: Kieszek
authors.initials: K
authors.lastname: Rafał
authors.affiliation: Warsaw Medical University, Poland.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Durlik
authors.affiliation: Warsaw Medical University, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Chmura
mesh_terms: D000328:Adult; D001706:Biopsy; D005260:Female; D015870:Gene Expression; D006085:Graft Survival; D051547:Heme Oxygenase-1 / Q000235:genetics; D006801:Humans; D051795:Hypoxia-Inducible Factor 1, alpha Subunit / Q000235:genetics*; D053583:Interleukin-1beta / Q000235:genetics; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D009926:Organ Preservation / Q000379:methods*; D015427:Reperfusion Injury / Q000235:genetics* / Q000517:prevention & control*; D042461:Vascular Endothelial Growth Factor A / Q000235:genetics
chemical_list: D051795:Hypoxia-Inducible Factor 1, alpha Subunit; D053583:Interleukin-1beta; D042461:Vascular Endothelial Growth Factor A; D051547:Heme Oxygenase-1