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Cold Preflush of Porcine Kidney Grafts Prior to Normothermic Machine Perfusion Aggravates Ischemia Reperfusion Injury.
Sci Rep. 2019 09 25; 9(1):13897.SR

Abstract

Normothermic machine perfusion (NMP) of kidney grafts is a promising new preservation method to improve graft quality and clinical outcome. Routinely, kidneys are washed out of blood remnants and cooled using organ preservation solutions prior to NMP. Here we assessed the effect of cold preflush compared to direct NMP. After 30 min of warm ischemia, porcine kidneys were either preflushed with cold histidine-tryptophan-ketoglutarate solution (PFNMP group) prior to NMP or directly subjected to NMP (DNMP group) using a blood/buffer solution. NMP was performed at a perfusion pressure of 75 mmHg for 6 h. Functional parameters were assessed as well as histopathological and biochemical analyses. Renal function as expressed by creatinine clearance, fractional excretion of sodium and total output of urine was inferior in PFNMP. Urine protein and neutrophil gelatinase-associated lipocalin (NGAL) concentrations as markers for kidney damage were significantly higher in the PFNMP group. Additionally, increased osmotic nephropathy was found after PFNMP. This study demonstrated that cold preflush prior to NMP aggravates ischemia reperfusion injury in comparison to direct NMP of warm ischemia-damaged kidney grafts. With increasing use of NMP systems for kidneys and other organs, further research into graft flushing during retrieval is warranted.

Authors+Show Affiliations

Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Aachen, Germany. gfabry@ukaachen.de. Department of Intensive Care and Intermediate Care, Medical Faculty, RWTH Aachen University, Aachen, Germany. gfabry@ukaachen.de.Institute for Laboratory Animal Science & Experimental Surgery, Medical Faculty, RWTH Aachen, Aachen, Germany.Department of Thoracic and Cardiovascular Surgery, Medical Faculty, RWTH Aachen, Aachen, Germany.Institute of Pathology & Division of Nephrology, Medical Faculty, RWTH Aachen, Aachen, Germany.Informatik 11-Embedded Software, RWTH Aachen University, Aachen, Germany.Informatik 11-Embedded Software, RWTH Aachen University, Aachen, Germany.Institute for Laboratory Animal Science & Experimental Surgery, Medical Faculty, RWTH Aachen, Aachen, Germany.Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Aachen, Germany.Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Aachen, Germany.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31554887

Citation

Fabry, Gregor, et al. "Cold Preflush of Porcine Kidney Grafts Prior to Normothermic Machine Perfusion Aggravates Ischemia Reperfusion Injury." Scientific Reports, vol. 9, no. 1, 2019, p. 13897.
Fabry G, Doorschodt BM, Grzanna T, et al. Cold Preflush of Porcine Kidney Grafts Prior to Normothermic Machine Perfusion Aggravates Ischemia Reperfusion Injury. Sci Rep. 2019;9(1):13897.
Fabry, G., Doorschodt, B. M., Grzanna, T., Boor, P., Elliott, A., Stollenwerk, A., Tolba, R. H., Rossaint, R., & Bleilevens, C. (2019). Cold Preflush of Porcine Kidney Grafts Prior to Normothermic Machine Perfusion Aggravates Ischemia Reperfusion Injury. Scientific Reports, 9(1), 13897. https://doi.org/10.1038/s41598-019-50101-7
Fabry G, et al. Cold Preflush of Porcine Kidney Grafts Prior to Normothermic Machine Perfusion Aggravates Ischemia Reperfusion Injury. Sci Rep. 2019 09 25;9(1):13897. PubMed PMID: 31554887.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cold Preflush of Porcine Kidney Grafts Prior to Normothermic Machine Perfusion Aggravates Ischemia Reperfusion Injury. AU - Fabry,Gregor, AU - Doorschodt,Benedict M, AU - Grzanna,Tim, AU - Boor,Peter, AU - Elliott,Aaron, AU - Stollenwerk,André, AU - Tolba,René H, AU - Rossaint,Rolf, AU - Bleilevens,Christian, Y1 - 2019/09/25/ PY - 2019/05/13/received PY - 2019/09/02/accepted PY - 2019/9/27/entrez PY - 2019/9/27/pubmed PY - 2020/10/28/medline SP - 13897 EP - 13897 JF - Scientific reports JO - Sci Rep VL - 9 IS - 1 N2 - Normothermic machine perfusion (NMP) of kidney grafts is a promising new preservation method to improve graft quality and clinical outcome. Routinely, kidneys are washed out of blood remnants and cooled using organ preservation solutions prior to NMP. Here we assessed the effect of cold preflush compared to direct NMP. After 30 min of warm ischemia, porcine kidneys were either preflushed with cold histidine-tryptophan-ketoglutarate solution (PFNMP group) prior to NMP or directly subjected to NMP (DNMP group) using a blood/buffer solution. NMP was performed at a perfusion pressure of 75 mmHg for 6 h. Functional parameters were assessed as well as histopathological and biochemical analyses. Renal function as expressed by creatinine clearance, fractional excretion of sodium and total output of urine was inferior in PFNMP. Urine protein and neutrophil gelatinase-associated lipocalin (NGAL) concentrations as markers for kidney damage were significantly higher in the PFNMP group. Additionally, increased osmotic nephropathy was found after PFNMP. This study demonstrated that cold preflush prior to NMP aggravates ischemia reperfusion injury in comparison to direct NMP of warm ischemia-damaged kidney grafts. With increasing use of NMP systems for kidneys and other organs, further research into graft flushing during retrieval is warranted. SN - 2045-2322 UR - https://www.unboundmedicine.com/medline/citation/31554887/Cold_Preflush_of_Porcine_Kidney_Grafts_Prior_to_Normothermic_Machine_Perfusion_Aggravates_Ischemia_Reperfusion_Injury_ L2 - https://doi.org/10.1038/s41598-019-50101-7 DB - PRIME DP - Unbound Medicine ER -