Transplant 01

Abstract

Aims: Renal preservation by normothermic machine preservation of kidneys may permit pretransplant measurement of organ function, and therefore viability, and may offer the prospect of improved organ preservation. The aim of this study was to compare the efficacy of preservation by normothermic ex-vivo perfusion with conventional cold techniques. Methods: Groups of pigs (n = 5) underwent left nephrectomy following warm ischaemic times (WIT) of 0 or 30 min. Kidneys were preserved either by static cold storage (UW solution, 4 °C) (CS), cold machine perfusion (UW solution 3–8 °C, 60 mmHg systolic) (CP) or warm machine perfusion (WP) using a tissue culture fluid and perfluorocarbon emulsion to increase oxygen capacity. Ex-vivo renal function was measured during WP by creatinine clearance. After 24 h, the kidney was auto-transplanted and a right nephrectomy performed. Results: Ex-vivo creatinine clearance was higher in the 0 WIT group (6.6 ± 5.3 versus 1.3 ± 1.4 mL min−1; P = 0.01). Fourteen-day animal survival rates following transplantation of 0 WIT kidneys preserved by CS, CP and WP were 3/5, 4/5 and 4/5, respectively (N.S.). Mean (SD) area under the creatinine curve levels following CS, CP and WP were 11 062 (6117), 9247 (8493) and 11 458 (5877), respectively (N.S.). Only 1/5 animals in each group survived for 14 days after a 30-min renal WIT. Conclusions: This study demonstrates that warm perfusion using a perfluorocarbon-based oxygen carrying is associated with equivalent efficacy for renal preservation as conventional hypothermic techniques. A further finding good ex-vivo function is associated with high rates of post-transplant renal viability.