Improved Normothermic Machine Perfusion After Short Oxygenated Hypothermic Machine Perfusion of Ischemically Injured Porcine Kidneys

Stina Lignell, MD; Stine Lohmann, MD; Kaithlyn M. Rozenberg, BSc; Henri G. D. Leuvenink, PhD; Merel B. F. Pool, MD; Kate R. Lewis, MSc; Cyril Moers, MD, PhD; James P. Hunter, MD, Bsc(hons); Rutger J. Ploeg, MD, PhD; Marco Eijken, PhD; Ulla Møldrup, MD; Søren Krag, PhD; Carla C. Baan, PhD; Bjarne Kuno Møller, MD, PhD; Anna Krarup Keller, MD, PhD; Bente Jespersen, MD, PhD

doi:10.1097/TXD.0000000000001108

Transplantation Direct (Feb 2021)

Improved Normothermic Machine Perfusion After Short Oxygenated Hypothermic Machine Perfusion of Ischemically Injured Porcine Kidneys

Stina Lignell, MD,
Stine Lohmann, MD,
Kaithlyn M. Rozenberg, BSc,
Henri G. D. Leuvenink, PhD,
Merel B. F. Pool, MD,
Kate R. Lewis, MSc,
Cyril Moers, MD, PhD,
James P. Hunter, MD, Bsc(hons),
Rutger J. Ploeg, MD, PhD,
Marco Eijken, PhD,
Ulla Møldrup, MD,
Søren Krag, PhD,
Carla C. Baan, PhD,
Bjarne Kuno Møller, MD, PhD,
Anna Krarup Keller, MD, PhD,
Bente Jespersen, MD, PhD

Affiliations

Stina Lignell, MD: 1 Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Stine Lohmann, MD: 1 Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Kaithlyn M. Rozenberg, BSc: 3 Nuffield Department of Surgical Sciences, Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom.
Henri G. D. Leuvenink, PhD: 4 Department of Surgery-Organ Donation and Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Merel B. F. Pool, MD: 4 Department of Surgery-Organ Donation and Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Kate R. Lewis, MSc: 4 Department of Surgery-Organ Donation and Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Cyril Moers, MD, PhD: 4 Department of Surgery-Organ Donation and Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
James P. Hunter, MD, Bsc(hons): 3 Nuffield Department of Surgical Sciences, Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom.
Rutger J. Ploeg, MD, PhD: 3 Nuffield Department of Surgical Sciences, Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom.
Marco Eijken, PhD: 2 Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark.
Ulla Møldrup, MD: 6 Department of Urology, Aarhus University Hospital, Aarhus, Denmark.
Søren Krag, PhD: 7 Department of Histopathology, Aarhus University Hospital, Aarhus, Denmark.
Carla C. Baan, PhD: 8 Department of Internal Medicine, Nephrology and Transplantation, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
Bjarne Kuno Møller, MD, PhD: 5 Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark.
Anna Krarup Keller, MD, PhD: 6 Department of Urology, Aarhus University Hospital, Aarhus, Denmark.
Bente Jespersen, MD, PhD: 1 Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.

DOI: https://doi.org/10.1097/TXD.0000000000001108
Journal volume & issue: Vol. 7, no. 2
p. e653

Abstract

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Background. In an era where global kidney shortage has pushed the field of transplantation towards using more marginal donors, modified kidney preservation techniques are currently being reviewed. Some techniques require further optimization before implementation in full scale transplantation studies. Using a porcine donation after circulatory death kidney model, we investigated whether initial kidney hemodynamics improved during normothermic machine perfusion if this was preceded by a short period of oxygenated hypothermic machine perfusion (oxHMP) rather than static cold storage (SCS). Methods. Kidneys subjected to 75 minutes of warm ischemia were randomly assigned to either SCS (n = 4) or SCS + oxHMP (n = 4), with a total cold storage time of 240 minutes. Cold preservation was followed by 120 minutes of normothermic machine perfusion with continuous measurement of hemodynamic parameters and renal function. Results. oxHMP preserved kidneys maintained significantly lower renal resistance throughout the normothermic machine perfusion period compared to SCS kidneys (P < 0.001), reaching lowest levels at 60 minutes with means of 0.71 ± 0.35 mm Hg/mL/min/100 g (SCS) and 0.45 ± 0.15 mm Hg/mL/min/100 g (oxHMP). Accordingly, the oxHMP group had a higher mean renal blood flow versus SCS kidneys (P < 0.001). oxHMP kidneys had higher oxygen consumption during normothermic machine perfusion compared to SCS preserved kidneys (P < 0.001). Creatinine clearance remained similar between groups (P = 0.665). Conclusions. Preceding oxHMP significantly improved initial normothermic machine perfusion hemodynamics and increased total oxygen consumption. With the long period of warm ischemia, immediate kidney function was not observed, reflected by the findings of low creatinine clearance in both groups.

Published in Transplantation Direct

ISSN: 2373-8731 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: http://journals.lww.com/transplantationdirect/Pages/default.aspx

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