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Effects of Oxygen During Long-term Hypothermic Machine Perfusion in a Porcine Model of Kidney Donation After Circulatory Death.
Transplantation 2019; 103(10):2057-2064T

Abstract

BACKGROUND

Hypothermic machine perfusion (HMP) has become standard care in many center's to preserve kidneys donated after circulatory death (DCD). Despite a significant reduction in metabolism at low temperatures, the remaining cellular activity requires oxygen. Because of the role and safety of oxygen during HMP has not been fully clarified, its supply during HMP is not standard yet. This study investigates the effect of administering oxygen during HMP on renal function in a porcine DCD model.

METHODS

After 30 minutes of warm ischemia, porcine slaughterhouse kidneys were preserved for 24 hours by means of cold storage (CS), or HMP with Belzer Machine Perfusion Solution supplemented with no oxygen, 21% or 100% oxygen. Next, kidneys were reperfused for 4 hours in a normothermic machine perfusion setup.

RESULTS

HMP resulted in significantly better kidney function during normothermic machine perfusion. Thiobarbituric acid-reactive substances, markers of oxidative stress, were significantly lower in HMP preserved kidneys. HMP preserved kidneys showed significantly lower aspartate aminotransferase and lactate dehydrogenase levels compared with kidneys preserved by CS. No differences were found between the HMP groups subjected to different oxygen concentrations. Adenosine triphosphate levels significantly improved during HMP when active oxygenation was applied.

CONCLUSIONS

This study showed that preservation of DCD kidneys with HMP is superior to CS. Although the addition of oxygen to HMP did not result in significantly improved renal function, beneficial effects were found in terms of reduced oxidative stress and energy status. Oxygen addition proofed to be safe and did not show detrimental effects.

Authors+Show Affiliations

Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.Department of Pathology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.Department of Surgery, Nuffield Department of Surgical Science, University of Oxford, Oxford, United Kingdom.IRTOMIT, INSERM U1082, Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France.Department for Surgical Research/General Surgery, University Hospital Essen, Essen, Germany.Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30951018

Citation

Venema, Leonie H., et al. "Effects of Oxygen During Long-term Hypothermic Machine Perfusion in a Porcine Model of Kidney Donation After Circulatory Death." Transplantation, vol. 103, no. 10, 2019, pp. 2057-2064.
Venema LH, Brat A, Moers C, et al. Effects of Oxygen During Long-term Hypothermic Machine Perfusion in a Porcine Model of Kidney Donation After Circulatory Death. Transplantation. 2019;103(10):2057-2064.
Venema, L. H., Brat, A., Moers, C., 't Hart, N. A., Ploeg, R. J., Hannaert, P., ... Leuvenink, A. H. G. D. (2019). Effects of Oxygen During Long-term Hypothermic Machine Perfusion in a Porcine Model of Kidney Donation After Circulatory Death. Transplantation, 103(10), pp. 2057-2064. doi:10.1097/TP.0000000000002728.
Venema LH, et al. Effects of Oxygen During Long-term Hypothermic Machine Perfusion in a Porcine Model of Kidney Donation After Circulatory Death. Transplantation. 2019;103(10):2057-2064. PubMed PMID: 30951018.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of Oxygen During Long-term Hypothermic Machine Perfusion in a Porcine Model of Kidney Donation After Circulatory Death. AU - Venema,Leonie H, AU - Brat,Aukje, AU - Moers,Cyril, AU - 't Hart,Nils A, AU - Ploeg,Rutger J, AU - Hannaert,Patrick, AU - Minor,Thomas, AU - Leuvenink,And Henri G D, AU - ,, PY - 2019/4/6/pubmed PY - 2019/4/6/medline PY - 2019/4/6/entrez SP - 2057 EP - 2064 JF - Transplantation JO - Transplantation VL - 103 IS - 10 N2 - BACKGROUND: Hypothermic machine perfusion (HMP) has become standard care in many center's to preserve kidneys donated after circulatory death (DCD). Despite a significant reduction in metabolism at low temperatures, the remaining cellular activity requires oxygen. Because of the role and safety of oxygen during HMP has not been fully clarified, its supply during HMP is not standard yet. This study investigates the effect of administering oxygen during HMP on renal function in a porcine DCD model. METHODS: After 30 minutes of warm ischemia, porcine slaughterhouse kidneys were preserved for 24 hours by means of cold storage (CS), or HMP with Belzer Machine Perfusion Solution supplemented with no oxygen, 21% or 100% oxygen. Next, kidneys were reperfused for 4 hours in a normothermic machine perfusion setup. RESULTS: HMP resulted in significantly better kidney function during normothermic machine perfusion. Thiobarbituric acid-reactive substances, markers of oxidative stress, were significantly lower in HMP preserved kidneys. HMP preserved kidneys showed significantly lower aspartate aminotransferase and lactate dehydrogenase levels compared with kidneys preserved by CS. No differences were found between the HMP groups subjected to different oxygen concentrations. Adenosine triphosphate levels significantly improved during HMP when active oxygenation was applied. CONCLUSIONS: This study showed that preservation of DCD kidneys with HMP is superior to CS. Although the addition of oxygen to HMP did not result in significantly improved renal function, beneficial effects were found in terms of reduced oxidative stress and energy status. Oxygen addition proofed to be safe and did not show detrimental effects. SN - 1534-6080 UR - https://www.unboundmedicine.com/medline/citation/30951018/Effects_of_oxygen_during_long_term_hypothermic_machine_perfusion_in_a_porcine_model_of_kidney_donation_after_circulatory_death_ L2 - http://dx.doi.org/10.1097/TP.0000000000002728 DB - PRIME DP - Unbound Medicine ER -