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An ex vivo comparison of adenosine and lidocaine solution and University of Wisconsin solution for hypothermic machine perfusion of porcine kidneys: potential for development.
J Surg Res 2017; 208:219-229JS

Abstract

BACKGROUND

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).

METHODS

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.

RESULTS

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.

CONCLUSIONS

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+Show Affiliations

Department of Surgery, Imperial College London, London, United Kingdom. Electronic address: karim.hamaoui08@imperial.ac.uk.Department of Surgery, Imperial College London, London, United Kingdom.Department of Bioengineering, Imperial College London, London, United Kingdom.Department of Bioengineering, Imperial College London, London, United Kingdom.Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.College of Public Health, Medical and Vet Sciences, James Cook University, Townsville, Queensland, Australia.Heart, Trauma and Sepsis Research Laboratory, College of Medicine and Dentistry, AITHM, James Cook University, Townsville, Queensland, Australia.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.

Pub Type(s)

Comparative Study
Evaluation Studies
Journal Article

Language

eng

PubMed ID

27993213

Citation

Hamaoui, Karim, et al. "An Ex Vivo Comparison of Adenosine and Lidocaine Solution and University of Wisconsin Solution for Hypothermic Machine Perfusion of Porcine Kidneys: Potential for Development." The Journal of Surgical Research, vol. 208, 2017, pp. 219-229.
Hamaoui K, Aftab A, Gowers S, et al. An ex vivo comparison of adenosine and lidocaine solution and University of Wisconsin solution for hypothermic machine perfusion of porcine kidneys: potential for development. J Surg Res. 2017;208:219-229.
Hamaoui, K., Aftab, A., Gowers, S., Boutelle, M., Cook, T., Rudd, D., ... Papalois, V. (2017). An ex vivo comparison of adenosine and lidocaine solution and University of Wisconsin solution for hypothermic machine perfusion of porcine kidneys: potential for development. The Journal of Surgical Research, 208, pp. 219-229. doi:10.1016/j.jss.2016.08.068.
Hamaoui K, et al. An Ex Vivo Comparison of Adenosine and Lidocaine Solution and University of Wisconsin Solution for Hypothermic Machine Perfusion of Porcine Kidneys: Potential for Development. J Surg Res. 2017;208:219-229. PubMed PMID: 27993213.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - An ex vivo comparison of adenosine and lidocaine solution and University of Wisconsin solution for hypothermic machine perfusion of porcine kidneys: potential for development. AU - Hamaoui,Karim, AU - Aftab,Adeel, AU - Gowers,Sally, AU - Boutelle,Martyn, AU - Cook,Terry, AU - Rudd,Donna, AU - Dobson,Geoffrey P, AU - Papalois,Vassilios, Y1 - 2016/09/12/ PY - 2016/03/22/received PY - 2016/07/29/revised PY - 2016/08/18/accepted PY - 2016/12/21/entrez PY - 2016/12/21/pubmed PY - 2017/7/19/medline KW - Adenosine KW - Hypothermic machine perfusion KW - Lidocaine KW - Normothermic reperfusion KW - Organ preservation KW - Reperfusion injury SP - 219 EP - 229 JF - The Journal of surgical research JO - J. Surg. Res. VL - 208 N2 - BACKGROUND: 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). METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. SN - 1095-8673 UR - https://www.unboundmedicine.com/medline/citation/27993213/An_ex vivo_comparison_of_adenosine_and_lidocaine_solution_and_University_of_Wisconsin_solution_for_hypothermic_machine_perfusion_of_porcine_kidneys:_potential_for_development_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-4804(16)30339-0 DB - PRIME DP - Unbound Medicine ER -