An automated and portable low-flow pulsatile perfusion system for organ preservation

Abstract

While machine preservation reduces the incidence of delayed graft function in renal transplant recipients, it is only used in 10% of kidney transplantations. The performance of our portable, low-flow-pulsatile organ perfusion system was examined in a canine kidney autotransplantation model. Grafts were stored for 72 h by simple cold preservation in University of Wisconsin (UW) solution, or by high or low-flow machine preservation After preservation, the grafts were autotransplanted and the animals were followed for 15 days. Graft function was better in machine-preserved kidneys. Tissue biochemistry indicated that machine preservation resulted in higher levels of adenine nucleotides and better histological integrity than the cold storage. While histology and biochemistry of machine-preserved groups were similar, electromicroscopy of high-flow grafts showed mild accumulation of intravenous debris and endothelial swelling. This study shows that a simplified machine perfusion technique is effective for organ preservation.

Pulsatile perfusion preservation of warm ischaemia-damaged experimental kidney grafts

“…Another possible indicator of viability is the increase in weight during machine perfusion27. An increase in graft weight during machine perfusion is associated with extravasation of perfusate, resulting in tissue oedema, and is considered to be a negative parameter of graft viability24, 27, 28. However, the prognostic value of weight increase was not supported in the present study as tissue oedema was significantly less in the MP‐PS group than in both cold storage groups after 7 days.…”

“…The degree of interstitial oedema in MP‐PS grafts was comparable to that of non‐ischaemic controls. The finding that weight increase had no prognostic significance may be explained by the fact that weight increase of grafts was limited to 15 per cent, as seen in the low‐flow perfusion group described by Yland and colleagues24. Low‐flow perfusion in their study compared favourably with high‐flow perfusion24.…”

“…Previous experiments showed that a pressure of 30 mmHg applied in the Airdrive ® system was not favourable for the perfusion of porcine kidneys (M. C. Schreinemachers and B. M. Doorschodt, unpublished data). Yland and co‐workers24 concluded that pressure‐controlled perfusion is advantageous as the perfusate flow is adjusted automatically to the vascular resistance or size of the organ, thereby facilitating safe perfusion of organs of any size24. The application of a lower perfusion pressure preset in the Airdrive ® possibly contributed to its beneficial effects, especially in these compromised grafts.…”

Preservation of Amputated Extremities by Extracorporeal Blood Perfusion; a Feasibility Study in a Porcine Model

“…The use of hemoglobin was thereafter abandoned and extremities were washed out [33,34], stored [35][36][37], perfused intermittently [34,38] or continuously [38][39][40] with fluids of different compositions, including physiological saline [41], Ringer Lactate [39], compositions using mannitol [42], and the standard organ preservation solutions University of Wisconsin [34,35,40,[43][44][45] and Euro Collins [33,39,43,45]. To increase the oxygenation of the perfused extremity, artificial oxygen carriers like Fluosol [36,38,46] and Fluorocarbon [38] have been used and one study even investigated the effect of hyperbaric oxygen chambers [47].…”

Donation after Cardiac Death Kidneys with Low Severity Pre-Arrest Acute Renal Failure

“…The beneficial effect may be mediated by maintenance of near physiological conditions during machine perfusion (25)(26)(27)(28)(29). Two reviews of DCD program at our center which were carried out from 1998 to 2002 ( This study is limited by the small number of transplants from donors with evidence of ARF.…”