Abstract
Background: Organ protection for transplantation is perfusion with ice-cold preservation solutions, although saline is also used in animal experiments and living donor transplantations. However, ice-cold perfusion can contribute to initial graft injury. Our aim was to test if cytoskeletal damage of parenchymal cells is caused by saline itself or by the ice-cold solution. Methods: F344 rat kidneys were flushed with cold (4 °C) saline, ischemic and sham kidneys were not perfused. In a separate set, F344 kidneys were flushed with saline or preservation solution at 4 or 15 °C. Ischemia time was 30 min. Results: Renal injury was significantly more severe following cold ischemia (CI) than after ischemia-reperfusion without flushing (ischemia/reperfusion (I/R)). Functional and morphologic damage was accompanied by severe loss of ezrin from glomerular and tubular epithelial cells after CI. Moreover, saline caused serious injury independently from its temperature, while the perfusion solution was more beneficial, especially at 4 °C. Conclusions: Flushing the kidney with ice-cold saline can cause more severe injury than ischemia-reperfusion at body temperature even during a short (30 min) ischemia. Saline perfusion can prolong recovery from ischemia in kidney transplantation, which can be prevented by using preservation solutions.
Highlights
Organ preservation historically focuses on the reduction in anoxic injury by cooling organs to ~4 ◦ C [1]
To investigate if flushing with 4 ◦ C cold saline protects from or aggravates ischemic acute kidney injury, we investigated Fischer rat kidneys subjected to 30 min ischemia with or without flushing with 4 ◦ C cold saline or preservation solution at low (4 ◦ C) or intermediate (15 ◦ C) temperatures
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Summary
Organ preservation historically focuses on the reduction in anoxic injury by cooling organs to ~4 ◦ C [1]. If the storage period is short, such as in the case of living donations [1,7] or rodent models of organ transplantation [8,9,10,11,12], simple cold saline is often used to flush the blood from the donor organ. Organ protection for transplantation is perfusion with ice-cold preservation solutions, saline is used in animal experiments and living donor transplantations. Conclusions: Flushing the kidney with ice-cold saline can cause more severe injury than ischemia-reperfusion at body temperature even during a short (30 min) ischemia. Saline perfusion can prolong recovery from ischemia in kidney transplantation, which can be prevented by using preservation solutions
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