title: An ex vivo comparison of adenosine and lidocaine solution and University of Wisconsin solution for hypothermic machine perfusion of porcine kidneys: potential for development.
abstract: The optimal hypothermic machine perfusion (HMP) solution has not yet been developed. An adenosine and lidocaine (AL) solution has been shown to be protective in cardiac preservation. The aim of the present study was to examine a modified AL solution with low Ca2+, 16 mM Mg2+, and 4% albumin on kidney preservation compared with University Wisconsin solution (UW).
  
  
  
  Twenty donation of organs after cardiac death porcine kidneys underwent HMP for 10 h (AL, n = 10; UW, n = 10) and then 2 h of normothermic reperfusion. Perfusion dynamics, functional parameters, histology, and real-time microdialysis were used to assess kidney responses and viability.
  
  
  
  During HMP, modified AL-perfused kidneys maintained higher flow rates (21.5 versus 17.9 mL/min/100 g, P = 0.01), with perfusion flow index during the first 3 h 25% greater than with UW (AL = 0.50 ± 0.2, UW = 0.40 ± 0.17 mL/min/100 g/mmHg; P = 0.03), followed by an increase in UW kidneys which was not significantly different to AL over the remaining 7 h (0.54 versus 0.55 mL/min/100 g/mmHg, respectively). During warm reperfusion, there were no significant differences between the two HMP groups in creatinine clearance, oxygen, and glucose consumption between groups. Modified AL kidneys had significantly lower perfusate lactates (3.1 versus 4.1 mmol/L, P = 0.04) during reperfusion and lower cortical lactate levels (AL = 0.66 ± 0.31, UW = 0.89 ± 0.53 mM, P = 0.33). Histology showed similar degrees of reperfusion injury.
  
  
  
  We conclude that HMP with modified AL solution showed improved perfusion compared with UW and lower perfusate lactate levels during warm reperfusion. Further modification of the AL composition is warranted and may lead to more rapid kidney stabilization and improved graft viability assessment, potentially expanding donor pools.
authors.affiliation: Department of Surgery, Imperial College London, London, United Kingdom. Electronic address: karim.hamaoui08@imperial.ac.uk.
authors.forename: Karim
authors.initials: K
authors.lastname: Hamaoui
authors.affiliation: Department of Surgery, Imperial College London, London, United Kingdom.
authors.forename: Adeel
authors.initials: A
authors.lastname: Aftab
authors.affiliation: Department of Bioengineering, Imperial College London, London, United Kingdom.
authors.forename: Sally
authors.initials: S
authors.lastname: Gowers
authors.affiliation: Department of Bioengineering, Imperial College London, London, United Kingdom.
authors.forename: Martyn
authors.initials: M
authors.lastname: Boutelle
authors.affiliation: Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.
authors.forename: Terry
authors.initials: T
authors.lastname: Cook
authors.affiliation: College of Public Health, Medical and Vet Sciences, James Cook University, Townsville, Queensland, Australia.
authors.forename: Donna
authors.initials: D
authors.lastname: Rudd
authors.affiliation: Heart, Trauma and Sepsis Research Laboratory, College of Medicine and Dentistry, AITHM, James Cook University, Townsville, Queensland, Australia.
authors.forename: Geoffrey P
authors.initials: GP
authors.lastname: Dobson
authors.affiliation: Department of Surgery, Imperial College London, London, United Kingdom; Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.
authors.forename: Vassilios
authors.initials: V
authors.lastname: Papalois
mesh_terms: D000241:Adenosine; D000493:Allopurinol; D000818:Animals; D005919:Glomerular Filtration Rate; D005978:Glutathione; D007036:Hypothermia, Induced; D007328:Insulin; D007668:Kidney; D008012:Lidocaine; D017551:Microdialysis; D019188:Organ Preservation Solutions; D010101:Oxygen Consumption; D010477:Perfusion; D011887:Raffinose; D013552:Swine
chemical_list: D007328:Insulin; D019188:Organ Preservation Solutions; C055206:University of Wisconsin-lactobionate solution; D000493:Allopurinol; D008012:Lidocaine; D005978:Glutathione; D000241:Adenosine; D011887:Raffinose
keywords: Adenosine; Hypothermic machine perfusion; Lidocaine; Normothermic reperfusion; Organ preservation; Reperfusion injury