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The effect on early renal function of various dynamic preservation strategies in a preclinical pig ischemia–reperfusion autotransplant model
Author(s) -
Darius Tom,
Gianello Pierre,
Vergauwen Martial,
Mourad Nizar,
Buemi Antoine,
De Meyer Martine,
Mourad Michel
Publication year - 2019
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.15100
Subject(s) - machine perfusion , medicine , perfusion , kidney , renal function , ischemia , cold storage , oxygenation , creatinine , urology , transplantation , kidney transplantation , anesthesia , surgery , biology , liver transplantation , horticulture
The aims of this study were to determine the most optimal timing to start machine perfusion during kidney preservation to improve early graft function and to evaluate the impact of temperature and oxygen supply during machine perfusion in a porcine ischemia–reperfusion autotransplant model. The left kidney of an approximately 40‐kg female Belgian Landrace pig was exposed to 30 minutes of warm ischemia via vascular clamping and randomized to 1 of 6 study groups: (1) 22‐hour static cold storage (SCS) (n = 6), (2) 22‐hour hypothermic machine perfusion (HMP) (n = 6), (3) 22‐hour oxygenated HMP (n = 7), (4) 20‐hour HMP plus 2‐hour normothermic perfusion (NP) (n = 6), (5) 20‐hour SCS plus 2‐hour oxygenated HMP (n = 7), and (6) 20‐hour SCS plus 2‐hour NP (n = 6). Graft recovery measured by serum creatinine level was significantly faster for continuous HMP preservation strategies compared with SCS alone and for all end‐ischemic strategies. The active oxygenated 22‐hour HMP group demonstrated a significantly faster recovery from early graft function compared with the 22‐hour nonactive oxygenated HMP group. Active oxygenation was also found to be an important modulator of a faster increase in renal flow during HMP preservation. Continuous oxygenated HMP applied from the time of kidney procurement until transplant might be the best preservation strategy to improve early graft function.