title: Comparison of Aerobic Preservation by Venous Systemic Oxygen Persufflation or Oxygenated Machine Perfusion of Warm-Ischemia-Damaged Porcine Kidneys.
abstract: OBJECTIVE
  The global shortage of donor organs for transplantation has necessitated the expansion of the organ pool through increased use of organs from less ideal donors. Venous systemic oxygen persufflation (VSOP) and oxygenated machine perfusion (OMP) have previously demonstrated beneficial results compared to cold storage (CS) in the preservation of warm-ischemia-damaged kidney grafts. The aim of this study was to compare the efficacy of VSOP and OMP for the preservation of warm-ischemia-damaged porcine kidneys using the recently introduced Ecosol preservation solution compared to CS using Ecosol or histidine-tryptophan-ketoglutarate solution (HTK).
  
  
  METHODS
  Kidneys from German Landrace pigs (n = 5/group) were retrieved and washed out with either Ecosol or HTK after 45 min of clamping of the renal pedicle. As controls, kidneys without warm ischemia, cold stored for 24 h in HTK, were employed. Following 24 h of preservation by VSOP, OMP, CS-Ecosol, or CS-HTK, renal function and damage were assessed during 1 h using the isolated perfused porcine kidney model.
  
  
  RESULTS
  During reperfusion, urine production was significantly higher in the VSOP and OMP groups than in the CS-HTK group; however, only VSOP could demonstrate lower urine protein concentrations and fractional excretion of sodium, which did not differ from the non-warm-ischemia-damaged control group. VSOP, CS-Ecosol, and controls showed better maintenance of the acid-base balance than CS-HTK. Reduced lipid peroxidation, as reflected in postreperfusion tissue thiobarbituric acid-reactive substance levels, was observed in the VSOP group compared to the OMP group, and the VSOP and CS-Ecosol groups had concentrations similar to the controls. The ratio of reduced to oxidized glutathione was higher in the VSOP, OMP, and CS-Ecosol groups than in the CS-HTK group and controls, with a higher ratio in the VSOP than in the OMP group.
  
  
  CONCLUSIONS
  VSOP was associated with mitigation of oxidative stress in comparison to OMP and CS. Preservation of warm-ischemia-damaged porcine kidneys by VSOP was improved compared to OMP and CS, and was comparable to preservation of non-warm-ischemia-damaged cold-stored kidneys.
authors.affiliation: Institute for Laboratory Animal Science and Experimental Surgery, RWTH Aachen University, Aachen, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Kalenski
authors.forename: Elina
authors.initials: E
authors.lastname: Mancina
authors.forename: Pascal
authors.initials: P
authors.lastname: Paschenda
authors.forename: Christian
authors.initials: C
authors.lastname: Beckers
authors.forename: Christian
authors.initials: C
authors.lastname: Bleilevens
authors.forename: Ľubomíra
authors.initials: Ľ
authors.lastname: Tóthová
authors.forename: Peter
authors.initials: P
authors.lastname: Boor
authors.forename: Dominik
authors.initials: D
authors.lastname: Gross
authors.forename: René H
authors.initials: RH
authors.lastname: Tolba
authors.forename: Benedict M
authors.initials: BM
authors.lastname: Doorschodt
mesh_terms: D000818:Animals; D005947:Glucose / Q000494:pharmacology; D007668:Kidney / Q000098:blood supply* / Q000473:pathology; D016030:Kidney Transplantation / Q000379:methods*; D008353:Mannitol / Q000494:pharmacology; D009926:Organ Preservation / Q000379:methods*; D010100:Oxygen / Q000097:blood*; D010477:Perfusion; D011189:Potassium Chloride / Q000494:pharmacology; D011343:Procaine / Q000494:pharmacology; D013552:Swine; D052096:Warm Ischemia / Q000009:adverse effects*
chemical_list: C039984:Bretschneider cardioplegic solution; D008353:Mannitol; D011343:Procaine; D011189:Potassium Chloride; D005947:Glucose; D010100:Oxygen