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Comparison of normothermic and hypothermic perfusion in porcine kidneys donated after cardiac death.
J Surg Res 2017; 216:35-45JS

Abstract

BACKGROUND

Normothermic machine perfusion (NMP) is an alternative strategy for preserving kidneys donated after cardiac death (DCD). The relative efficacy of prolonged NMP compared to hypothermic machine perfusion (HMP) in DCD kidneys with moderate ischemic injury is undetermined. This study compares NMP and HMP kidney preservation in a porcine DCD model.

METHODS

Ten porcine kidneys underwent NMP or HMP preservation following 45 minutes of warm ischemia and 5 hours of cold ischemia. After 8 hours of machine preservation, hemodynamic stability, renal function, perfusate biomarkers, and histologic integrity were assessed in a simulated reperfusion model.

RESULTS

During simulated reperfusion, no differences were observed in oxygen consumption, urine production, creatinine clearance, fractional excretion of sodium, proteinuria, and perfusate levels of lactate dehydrogenase and aspartate aminotransferase. Resistance was no different after 30 minutes of simulated reperfusion. Histologically, NMP kidneys demonstrated increased vacuolization after preservation and greater loss of tubular integrity after simulated reperfusion. Perfusate levels of alkaline phosphatase (AP) and gamma glutamyltransferase (GGT) were higher in NMP kidneys during preservation, but upon simulated reperfusion, AP and GGT levels were higher in HMP-preserved kidneys. Peak AP and GGT during simulated reperfusion of HMP kidneys were over 14 times higher than peak AP and GGT during preservation of NMP kidneys.

CONCLUSIONS

NMP provided comparable preservation of renal function as HMP and minimized AP and GGT release upon reperfusion.

Authors+Show Affiliations

Transplant Center, Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio. Electronic address: blumm@ccf.org.Transplant Center, Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio.Transplant Center, Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio.Transplant Center, Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio.Transplant Center, Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio.Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio.Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio.Department of Immunology, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio.Transplant Center, Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio.

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

28807212

Citation

Blum, Matthew F., et al. "Comparison of Normothermic and Hypothermic Perfusion in Porcine Kidneys Donated After Cardiac Death." The Journal of Surgical Research, vol. 216, 2017, pp. 35-45.
Blum MF, Liu Q, Soliman B, et al. Comparison of normothermic and hypothermic perfusion in porcine kidneys donated after cardiac death. J Surg Res. 2017;216:35-45.
Blum, M. F., Liu, Q., Soliman, B., Dreher, P., Okamoto, T., Poggio, E. D., ... Quintini, C. (2017). Comparison of normothermic and hypothermic perfusion in porcine kidneys donated after cardiac death. The Journal of Surgical Research, 216, pp. 35-45. doi:10.1016/j.jss.2017.04.008.
Blum MF, et al. Comparison of Normothermic and Hypothermic Perfusion in Porcine Kidneys Donated After Cardiac Death. J Surg Res. 2017;216:35-45. PubMed PMID: 28807212.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of normothermic and hypothermic perfusion in porcine kidneys donated after cardiac death. AU - Blum,Matthew F, AU - Liu,Qiang, AU - Soliman,Basem, AU - Dreher,Paul, AU - Okamoto,Toshihiro, AU - Poggio,Emilio D, AU - Goldfarb,David A, AU - Baldwin,William M,3rd AU - Quintini,Cristiano, Y1 - 2017/04/20/ PY - 2016/11/11/received PY - 2017/03/18/revised PY - 2017/04/11/accepted PY - 2017/8/16/entrez PY - 2017/8/16/pubmed PY - 2017/10/4/medline KW - Donation after cardiac death KW - Kidney transplantation KW - Normothermia KW - Organ preservation KW - Perfusion KW - Swine SP - 35 EP - 45 JF - The Journal of surgical research JO - J. Surg. Res. VL - 216 N2 - BACKGROUND: Normothermic machine perfusion (NMP) is an alternative strategy for preserving kidneys donated after cardiac death (DCD). The relative efficacy of prolonged NMP compared to hypothermic machine perfusion (HMP) in DCD kidneys with moderate ischemic injury is undetermined. This study compares NMP and HMP kidney preservation in a porcine DCD model. METHODS: Ten porcine kidneys underwent NMP or HMP preservation following 45 minutes of warm ischemia and 5 hours of cold ischemia. After 8 hours of machine preservation, hemodynamic stability, renal function, perfusate biomarkers, and histologic integrity were assessed in a simulated reperfusion model. RESULTS: During simulated reperfusion, no differences were observed in oxygen consumption, urine production, creatinine clearance, fractional excretion of sodium, proteinuria, and perfusate levels of lactate dehydrogenase and aspartate aminotransferase. Resistance was no different after 30 minutes of simulated reperfusion. Histologically, NMP kidneys demonstrated increased vacuolization after preservation and greater loss of tubular integrity after simulated reperfusion. Perfusate levels of alkaline phosphatase (AP) and gamma glutamyltransferase (GGT) were higher in NMP kidneys during preservation, but upon simulated reperfusion, AP and GGT levels were higher in HMP-preserved kidneys. Peak AP and GGT during simulated reperfusion of HMP kidneys were over 14 times higher than peak AP and GGT during preservation of NMP kidneys. CONCLUSIONS: NMP provided comparable preservation of renal function as HMP and minimized AP and GGT release upon reperfusion. SN - 1095-8673 UR - https://www.unboundmedicine.com/medline/citation/28807212/Comparison_of_normothermic_and_hypothermic_perfusion_in_porcine_kidneys_donated_after_cardiac_death_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-4804(17)30206-8 DB - PRIME DP - Unbound Medicine ER -