Abstract
Normothermic machine perfusion (NMP) of donor kidneys provides the opportunity for improved graft preservation and objective pre-transplant ex-vivo organ assessment. Currently, a multitude of perfusion solutions exist for renal NMP. This study aimed to evaluate four different perfusion solutions side-by-side and determine the influence of different perfusate compositions on measured renal perfusion parameters. Porcine kidneys and blood were obtained from a slaughterhouse. Kidneys underwent NMP at 37°C for 7 hours, with 4 different perfusion solutions (n = 5 per group). Group 1 consisted of red blood cells (RBCs) and a perfusion solution based on Williams’ Medium E. Group 2 consisted of RBCs, albumin and a balanced electrolyte composition. Group 3 contained RBCs and a medium based on a British clinical NMP solution. Group 4 contained RBCs and a medium used in 24-hour perfusion experiments. NMP flow patterns for solutions 1 and 2 were similar, solutions 3 and 4 showed lower but more stable flow rates. Thiobarbituric acid reactive substances were significantly higher in solution 1 and 4 compared to the other groups. Levels of injury marker N-acetyl-β-D glucosaminidase were significantly lower in solution 2 in comparison with solution 3 and 4. This study illustrates that the perfusate composition during NMP significantly impacts the measured perfusion and injury parameters and thus affects the interpretation of potential viability markers. Further research is required to investigate the individual influences of principal perfusate components to determine the most optimal conditions during NMP and eventually develop universal organ assessment criteria.
Highlights
IntroductionThe standard donor kidney preservation method is static cold storage (SCS)
Worldwide, the standard donor kidney preservation method is static cold storage (SCS)
General interest in renal normothermic ex-vivo machine perfusion techniques is rising, but clinical evidence remains limited with only one ongoing clinical normothermic machine perfusion (NMP) trial
Summary
The standard donor kidney preservation method is static cold storage (SCS). In the Netherlands hypothermic machine perfusion (HMP) is clinically used to preserve all deceased donor kidneys. Due to the increased use of these less than optimal quality donor kidneys, it is of the utmost importance to establish even further optimised strategies for robust and objective pre-transplant assessment as well as preservation. The use of normothermic machine perfusion (NMP) for these deceased-donor kidneys is increasingly being considered. For adequate organ assessment and resuscitation, longer NMP times are conceivably necessary [7] This method provides the opportunity for pre-transplant organ diagnostics, improved preservation, and ex-vivo interventions prior to transplantation to improve post-transplant renal function. Many transplant centres have started to invest in this promising normothermic ex-vivo perfusion strategy Among these centres, a wide variety of NMP perfusion solutions exists. Our aim was to analyse to what extent different perfusate compositions as a whole impact electrolyte balance, renal function, and injury markers measured during NMP
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