title: The effect of prolonged of warm ischaemic injury on renal function in an experimental ex vivo normothermic perfusion system.
abstract: BACKGROUND
  Donation after circulatory death (DCD) kidney transplants inevitably sustain a degree of warm ischaemic injury, which is manifested clinically as delayed graft function. The aim of this study was to define the effects of prolonged periods of warm ischaemic injury on renal function in a normothermic haemoperfused kidney model.
  
  
  METHODS
  Porcine kidneys were subjected to 15, 60, 90 (n = 6 per group) and 120 min (n = 4) of in situ warm ischaemia (WI) and then retrieved, flushed with cold preservation fluid and stored in ice for 2 h. Kidneys then underwent 3 h of normothermic reperfusion with a whole blood-based perfusate using an ex vivo circuit developed from clinical grade cardiopulmonary bypass technology.
  
  
  RESULTS
  Creatinine clearance, urine output and fractional excretion of sodium deteriorated sequentially with increasing warm time. Renal function was severely compromised after 90 or 120 min of WI but haemodynamic, metabolic and histological parameters demonstrated the viability of kidneys subjected to prolonged warm ischaemia.
  
  
  CONCLUSIONS
  Isolated kidney perfusion using a warm, oxygenated, red cell-based perfusate allows an accurate ex vivo assessment of the potential for recovery from warm ischaemic injury. Prolonged renal warm ischaemic injury caused a severe decrement in renal function but was not associated with tissue necrosis.
authors.affiliation: Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK. sh744@cam.ac.uk.|Department of Surgery, University of Cambridge, NIHR Cambridge Biomedical Research Centre, Cambridge, CB2 0QQ, UK. sh744@cam.ac.uk.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Hosgood
authors.affiliation: Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK. keyurkshah@gmail.com.
authors.forename: K
authors.initials: K
authors.lastname: Shah
authors.affiliation: Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK. mp502@le.ac.uk.
authors.forename: M
authors.initials: M
authors.lastname: Patel
authors.affiliation: Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK. mln31@cam.ac.uk.|Department of Surgery, University of Cambridge, NIHR Cambridge Biomedical Research Centre, Cambridge, CB2 0QQ, UK. mln31@cam.ac.uk.
authors.forename: M L
authors.initials: ML
authors.lastname: Nicholson
mesh_terms: D000818:Animals; D015415:Biomarkers / Q000652:urine; D003404:Creatinine / Q000097:blood; D005260:Female; D006439:Hemodynamics; D007668:Kidney / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology*; D007677:Kidney Function Tests; D010101:Oxygen Consumption; D015424:Reperfusion; D012964:Sodium / Q000378:metabolism; D034421:Sus scrofa; D052096:Warm Ischemia
chemical_list: D015415:Biomarkers; D012964:Sodium; D003404:Creatinine