Subnormothermic Oxygenated Perfusion Optimally Preserves Donor Kidneys Ex Vivo
| Autor: | Mahms Richard-Mohamed, Alp Sener, Larry Jiang, Hemant Sharma, Aaron Haig, Shahid Aquil, Rabindra N. Bhattacharjee, Qizhi Sun, Bijad Alharbi, Sean Luke, Aushanth Ruthirakanthan, Mauro E. Tun-Abraham, Patrick Luke |
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| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
donation after cardiac death ischemia-reperfusion injury subnormothermia 030232 urology & nephrology Urology kidney transplantation Cold storage 030204 cardiovascular system & hematology lcsh:RC870-923 03 medical and health sciences 0302 clinical medicine Translational Research medicine Kidney transplantation Acute tubular necrosis Kidney business.industry prolonged storage Oxygenation lcsh:Diseases of the genitourinary system. Urology medicine.disease Transplantation medicine.anatomical_structure Nephrology Renal blood flow oxygenated perfusion business Perfusion |
| Zdroj: | Kidney International Reports Kidney International Reports, Vol 4, Iss 9, Pp 1323-1333 (2019) |
| ISSN: | 2468-0249 |
| Popis: | Introduction The current methods of preserving donor kidneys in nonoxygenated cold conditions minimally protect the kidney against ischemia-reperfusion injury (IRI), a major source of complications in clinical transplantation. However, preserving kidneys with oxygenated perfusion is not currently feasible due to the lack of an ideal perfusion mechanism that facilitates perfusion with blood at warm temperature. Here, we have designed an innovative renal pump circuit system that can perfuse blood or acellular oxygen carrier under flexible temperatures, pressures, and oxygenation. We have tested this apparatus to study optimal conditions of storage of our porcine model of donation after cardiac death (DCD) kidneys. Methods Porcine kidneys were retrieved after 30 minutes of cross-clamping renal pedicles in situ. Cessation of blood mimics postcardiac death in humans and simulates DCD warm ischemic injury. Procured kidneys were flushed and subjected to static cold storage (SCS) for 4 hours. For warm perfusion, kidneys were cannulated for pulsatile oxygenated perfusion with blood:PlasmaLyte for 4 hours at 15 °C, 22 °C, and 37 °C. To mimic posttransplant scenario, all kidneys were reperfused with blood for an additional 4 hours at 37 °C. Results Compared with all other groups, 22 °C perfusion resulted in significant reduction of acute tubular necrosis (ATN), apoptosis, kidney damage markers, Toll-like receptor signaling, and cytokine production. It was associated with maximal renal blood flow and urine output. Kidneys stored at 15 °C thrombosed within 2 hours under this condition. Martius Scarlet Blue staining confirmed that 22 °C was the optimal temperature to minimize hemorrhage and blood clots. Conclusion Our novel study shows that oxygenated perfusion at near-room-temperature provides optimal donor kidney storage conditions. Graphical abstract |
| Databáze: | OpenAIRE |
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