Abstract
Simple SummaryIn this study, we explore for the first time an innovative tool for organ preservation aimed to preventing ischemia reperfusion injury (IRI) in marginal kidneys from expanded criteria donors (ECD) unsuitable for transplantation. Ex vivo hypothermic oxygenated perfusion (HOPE) with and without MSC-derived EV and normothermic reperfusion (NR) with artificial blood composed of bovine hemoglobin were applied on kidneys to evaluate global renal ischemic damage score, renal ultrastructure, mitochondrial distress, apoptosis, cell proliferation index, and the mediators of energy metabolism. Our study demonstrates that kidney conditioning with HOPE+EV arrests the ischemic damage, prevents reoxygenation-dependent injury, and preserves tissue integrity. EV delivery during HOPE can be considered a new organ preservation strategy to increase the donor pool and improving transplant outcome. The originality of our study lies an EV and HOPE combined novel setting use in kidneys from ECD, but also in any condition for graft dysfunction such as ischemia/reperfusion.The poor availability of kidney for transplantation has led to a search for new strategies to increase the donor pool. The main option is the use of organs from extended criteria donors. We evaluated the effects of hypothermic oxygenated perfusion (HOPE) with and without extracellular vesicles (EV) derived from mesenchymal stromal cells on ischemic/reperfusion injury of marginal kidneys unsuitable for transplantation. For normothermic reperfusion (NR), we used artificial blood as a substitute for red blood cells. We evaluated the global renal ischemic dam-age score (GRS), analyzed the renal ultrastructure (RU), cytochrome c oxidase (COX) IV-1 (a mitochondrial distress marker), and caspase-3 renal expression, the tubular cell proliferation index, hepatocyte growth factor (HGF) and vascular endothelial growth factor (VEGF) tissue levels, and effluent lactate and glucose levels. HOPE+EV kidneys had lower GRS and better RU, higher COX IV-1 expression and HGF and VEGF levels and lower caspase-3 expression than HOPE kidneys. During NR, HOPE+EV renal effluent had lower lactate release and higher glucose levels than HOPE renal effluent, suggesting that the gluconeogenesis system in HOPE+EV group was pre-served. In conclusion, EV delivery during HOPE can be considered a new organ preservation strategy for increasing the donor pool and improving transplant outcome.
Highlights
Kidney transplantation represents the gold-standard treatment for patients with endstage renal disease
Using a kidney donation after circulatory death (DCD) rat model, we have demonstrated that mesenchymal stromal cells (MSC)/MSC-derived extracellular vesicles (EV) delivered during HMP protected kidneys from ischemic injury
All kidneys were reperfused with hemoglobin-based oxygen carriers (HBOCs) (NR hypothermic oxygenated perfusion (HOPE) n = 5; normothermic reperfusion (NR) HOPE +EV n = 5)
Summary
Kidney transplantation represents the gold-standard treatment for patients with endstage renal disease. The huge gap between the number of transplant candidates and organ availability has had a significant impact on patient morbidity and mortality. New therapies such as mesenchymal stromal cells (MSC) and drug monitoring have improved graft outcomes [1,2,3], new strategies are needed for increasing the donor pool. ECD organs are more exposed to ischemic/reperfusion injury (IRI) compared to those from standard donors Their use presents an increased risk of primary non-function, delayed graft function, and decreased graft survival [6,7,8,9,10]
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