Normothermic Ex Vivo Kidney Perfusion for Graft Quality Assessment Prior to Transplantation

5 years ago

Normothermic Ex Vivo Kidney Perfusion for Graft Quality Assessment Prior to Transplantation

Lisa A. Robinson, Luke S. Dingwell, J. Morit007A Kaths, Ivan Linares, Mátyás Hamar, David Grant, Anand Ghanekar, Markus Selzner, Jun Yu Cen, Paul Yip, Sujani Ganesh, Darius Bagli, Istvan Mucsi, Rohan John, Juan Echeverri, Peter Urbanellis

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 prior to transplantation. Kidneys from 30kg pigs were recovered in a model of heart-beating donation (HBD) (group A), following 30min of warm ischemia (WI) (group B), or 60min WI (group C) (n=5/group). Following 8hrs of NEVKP, contralateral kidneys were resected, grafts autotransplanted, and pigs followed for 3 days. Following transplantation, renal function measured by peak serum creatinine, differed significantly among groups (p<0.05). Throughout NEVKP, intrarenal resistance (IRR) was lowest in groups A vs. B vs. C (p<0.05). IRR at initiation of NEVKP correlated with postoperative renal function (p<0.001 at NEVKP hr1). Markers of acid base homeostasis (pH, HCO3-, base excess) were different among groups (p<0.05) and correlated with posttransplant renal function (p<0.001 for pH at NEVKP hr1). Similarly, lactate and AST were lowest in non-injured grafts vs. DCD kidneys (p<0.05) and correlated with posttransplant kidney function (p<0.001 for lactate at NEVKP hr1). In conclusion, assessment of perfusion characteristics and clinically available perfusate biomarkers during NEVKP allows predicting post transplant graft function. Thus, NEVKP might allow decision-making whether grafts are suitable for transplantation. This article is protected by copyright. All rights reserved.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1111/ajt.14491