title: Normothermic Ex Vivo Kidney Perfusion Following Static Cold Storage-Brief, Intermediate, or Prolonged Perfusion for Optimal Renal Graft Reconditioning?
abstract: Normothermic ex vivo kidney perfusion (NEVKP) demonstrated superior results compared to hypothermic storage in donation after circulatory death (DCD) kidney transplantation. It is unknown whether an optimal perfusion time exists following hypothermic storage to allow for the recovery of renal grafts from cold ischemic injury. In a porcine model of DCD kidney autotransplantation, the impact of initial static cold storage (SCS) (8 h) followed by various periods of NEVKP recovery was investigated: group A, 8 hSCS only (control); group B, 8 hSCS + 1 hNEVKP (brief NEVKP); group C, 8 hSCS + 8 hNEVKP (intermediate NEVKP); and group D, 8 hSCS + 16 hNEVKP (prolonged NEVKP). All grafts were preserved and transplanted successfully. One animal in group D was sacrificed and excluded by postoperative day 3 due to hind limb paralysis, but demonstrated good renal function. Postoperative graft assessment during 8 days' follow-up demonstrated lowest levels of peak serum creatinine for intermediate (C) and prolonged (D) NEVKP (p = 0.027). Histological assessment on day 8 demonstrated a significant difference in tubular injury (p = 0.001), with highest values for group B. These results suggest that longer periods of NEVKP following SCS are feasible and safe for postponing surgical transplant procedure and superior to brief NEVKP, reducing the damage caused during cold ischemic storage of renal grafts.
authors.affiliation: Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.|Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada.|Department of General, Visceral, and Transplantation Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
authors.forename: J M
authors.initials: JM
authors.lastname: Kaths
authors.affiliation: Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Echeverri
authors.affiliation: Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: I
authors.initials: I
authors.lastname: Linares
authors.affiliation: Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: J Y
authors.initials: JY
authors.lastname: Cen
authors.affiliation: Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Ganesh
authors.affiliation: Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Hamar
authors.affiliation: Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: P
authors.initials: P
authors.lastname: Urbanellis
authors.affiliation: Laboratory Medicine & Pathobiology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: P
authors.initials: P
authors.lastname: Yip
authors.affiliation: Laboratory Medicine & Pathobiology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: R
authors.initials: R
authors.lastname: John
authors.affiliation: Departments of Surgery (Urology) & Physiology, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: D
authors.initials: D
authors.lastname: Bagli
authors.affiliation: Multi Organ Transplant Program, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: I
authors.initials: I
authors.lastname: Mucsi
authors.affiliation: Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Ghanekar
authors.affiliation: Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: D
authors.identifier: http://orcid.org/0000-0003-4468-8276
authors.initials: D
authors.lastname: Grant
authors.affiliation: Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada.|Program in Cell Biology, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.
authors.forename: L A
authors.initials: LA
authors.lastname: Robinson
authors.affiliation: Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Selzner
mesh_terms: D000818:Animals; D001833:Body Temperature Regulation; D006801:Humans; D066298:In Vitro Techniques; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D023421:Models, Animal; D010477:Perfusion / Q000379:methods*; D013552:Swine
keywords: animal models: porcine; autotransplantation; basic (laboratory) research/science; donors and donation: donation after circulatory death (DCD); ischemia-reperfusion injury (IRI); kidney transplantation/nephrology; organ perfusion and preservation; organ transplantation in general; regenerative medicine; translational research/science