Normothermic ex vivo kidney perfusion for graft quality assessment prior to transplantation

J. Moritz Kaths, Mátyás Hamar, Juan Echeverri, Ivan Linares, Peter Urbanellis, Jun Yu Cen, Sujani Ganesh, Luke S. Dingwell, Paul Yip, Rohan John, Darius Bagli, I. Mucsi, Anand Ghanekar, David Grant, Lisa A. Robinson, Markus Selzner

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Abstract

Normothermic ex vivo kidney perfusion (NEVKP) represents a novel approach for graft preservation and functional improvement in kidney transplantation. We investigated whether NEVKP also allows graft quality assessment before transplantation. Kidneys from 30-kg pigs were recovered in a model of heart-beating donation (group A) after 30 minutes (group B) or 60 minutes (group C) (n = 5/group) of warm ischemia. After 8 hours of NEVKP, contralateral kidneys were resected, grafts were autotransplanted, and the pigs were followed for 3 days. After transplantation, renal function measured based on peak serum creatinine differed significantly among groups (P <.05). Throughout NEVKP, intrarenal resistance was lowest in group A and highest in group C (P <.05). intrarenal resistance at the initiation of NEVKP correlated with postoperative renal function (P <.001 at NEVKP hour 1). Markers of acid-base homeostasis (pH, HCO3 , base excess) differed among groups (P <.05) and correlated with posttransplantation renal function (P <.001 for pH at NEVKP hour 1). Similarly, lactate and aspartate aminotransferase were lowest in noninjured grafts versus donation after circulatory death kidneys (P <.05) and correlated with posttransplantation kidney function (P <.001 for lactate at NEVKP hour 1). In conclusion, assessment of perfusion characteristics and clinically available perfusate biomarkers during NEVKP allows the prediction of posttransplantation graft function. Thus, NEVKP might allow decision-making regarding whether grafts are suitable for transplantation.

Original languageEnglish
Pages (from-to)580-589
Number of pages10
JournalAmerican Journal of Transplantation
Volume18
Issue number3
DOIs
Publication statusPublished - Mar 1 2018

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Keywords

  • animal models: porcine
  • autotransplantation
  • basic (laboratory) research/science
  • ischemia–reperfusion injury (IRI)
  • kidney transplantation/nephrology
  • organ perfusion and preservation
  • organ transplantation in general
  • regenerative medicine
  • surgical technique
  • translational research/science

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

Cite this

Kaths, J. M., Hamar, M., Echeverri, J., Linares, I., Urbanellis, P., Cen, J. Y., Ganesh, S., Dingwell, L. S., Yip, P., John, R., Bagli, D., Mucsi, I., Ghanekar, A., Grant, D., Robinson, L. A., & Selzner, M. (2018). Normothermic ex vivo kidney perfusion for graft quality assessment prior to transplantation. American Journal of Transplantation, 18(3), 580-589. https://doi.org/10.1111/ajt.14491