Dynamic Parameters of Hypothermic Machine Perfusion—An Image of Initial Graft Function in Adult Kidney Transplantation?

Weberskirch, Sebastian; Katou, Shadi; Reuter, Stefan; Kneifel, Felicia; Morgül, Mehmet Haluk; Becker, Felix; Houben, Philipp; Pascher, Andreas; Vogel, Thomas; Radünz, Sonia

doi:10.3390/jcm11195698

Cited by 4 publications

(9 citation statements)

References 25 publications

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“…The flow was consistent with our previous findings, 16 and within the range of DCD pig kidneys 28 and DBD, healthy porcine grafts. Consistently, lower flow and higher resistance were observed during HMP with 29 or without 30 oxygen. Notably, low renal arterial flow and high resistance were associated with allograft dysfunction during NMP 8 and HMP.…”

Section: Discussionsupporting

confidence: 69%

Acellular Perfusate is an Adequate Alternative to Packed Red Blood Cells During Normothermic Human Kidney Perfusion

Longchamp,

Fontan,

Aburawi

et al. 2024

Transplantation Direct

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Background. Brief normothermic machine perfusion is increasingly used to assess and recondition grafts before transplant. During normothermic machine perfusion, metabolic activity is typically maintained using red blood cell (RBC)–based solutions. However, the utilization of RBCs creates important logistical constraints. This study explored the feasibility of human kidney normothermic perfusion using William’s E–based perfusate with no additional oxygen carrier. Methods. Sixteen human kidneys declined for transplant were perfused with a perfusion solution containing packed RBCs or William’s E medium only for 6 h using a pressure-controlled system. The temperature was set at 37 °C. Renal artery resistance, oxygen extraction, metabolic activity, energy metabolism, and histological features were evaluated. Results. Baseline donor demographics were similar in both groups. Throughout perfusion, kidneys perfused with William’s E exhibited improved renal flow (P = 0.041) but similar arterial resistance. Lactic acid levels remained higher in kidneys perfused with RBCs during the first 3 h of perfusion but were similar thereafter (P = 0.95 at 6 h). Throughout perfusion, kidneys from both groups exhibited comparable behavior regarding oxygen consumption (P = 0.41) and reconstitution of ATP tissue concentration (P = 0.55). Similarly, nicotinamide adenine dinucleotide levels were preserved during perfusion. There was no evidence of histological damage caused by either perfusate. Conclusions. In human kidneys, William’s E medium provides a logistically convenient, off-the-shelf alternative to packed RBCs for up to 6 h of normothermic machine perfusion.

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Section: Discussionsupporting

confidence: 69%

Acellular Perfusate is an Adequate Alternative to Packed Red Blood Cells During Normothermic Human Kidney Perfusion

Longchamp,

Fontan,

Aburawi

et al. 2024

Transplantation Direct

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“…Of these, 36 did not meet the selection criteria and were excluded. In total, there were 55 manuscripts included (N = 42 MP vs. SCS articles [ 9 , 15 , 17 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 ]; N = 13 NRP vs. ISP articles [ 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 ,…”

Section: Resultsmentioning

confidence: 99%

“…There were 22 (53.7%) studies that involved kidney pairs [17,[20][21][22]24,28,[30][31][32][33][34]36,41,[44][45][46][47][48]52,57]. Studies were conducted across the world; 25 (61.0%) were single-center efforts [9,17,22,[24][25][26][27][28][29][30]35,[38][39][40][41][42][43]45,46,48,49,51,54,55,57], while 16 (39.0%) involved multiple centers [15,20,21,23,[31]…”

Section: Machine Perfusion (Mp) Vs Static Cold Storage (Scs)mentioning

confidence: 99%

“…A total of 39 studies investigated the effects of HMP [9,17,, while 2 studies focused on NMP [15,72]. Among MP studies, 10 (24.4%) were retrospective studies [23,29,[37][38][39]42,43,49,50,54], 17 (41.5%) were prospective studies [9,17,21,22,[24][25][26][27][28]35,40,41,46,48,55,57], and 14 (34.2%) were randomized control trials [15,20,[30][31][32][33][34]36,44,47,[51][52][53]56]. There were 22 (53.7%) studies that involved kidney pairs [17,[20][21][22]24,28,<...…”

Section: Machine Perfusion (Mp) Vs Static Cold Storage (Scs)mentioning

confidence: 99%

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Perfusion Techniques in Kidney Allograft Preservation to Reduce Ischemic Reperfusion Injury: A Systematic Review and Meta-Analysis

Hasjim,

Sanders,

Alexander

et al. 2024

Antioxidants

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The limited supply and rising demand for kidney transplantation has led to the use of allografts more susceptible to ischemic reperfusion injury (IRI) and oxidative stress to expand the donor pool. Organ preservation and procurement techniques, such as machine perfusion (MP) and normothermic regional perfusion (NRP), have been developed to preserve allograft function, though their long-term outcomes have been more challenging to investigate. We performed a systematic review and meta-analysis to examine the benefits of MP and NRP compared to traditional preservation techniques. PubMed (MEDLINE), Embase, Cochrane, and Scopus databases were queried, and of 13,794 articles identified, 54 manuscripts were included (n = 41 MP; n = 13 NRP). MP decreased the rates of 12-month graft failure (OR 0.67; 95%CI 0.55, 0.80) and other perioperative outcomes such as delayed graft function (OR 0.65; 95%CI 0.54, 0.79), primary nonfunction (OR 0.63; 95%CI 0.44, 0.90), and hospital length of stay (15.5 days vs. 18.4 days) compared to static cold storage. NRP reduced the rates of acute rejection (OR 0.48; 95%CI 0.35, 0.67) compared to in situ perfusion. Overall, MP and NRP are effective techniques to mitigate IRI and play an important role in safely expanding the donor pool to satisfy the increasing demands of kidney transplantation.

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“…However, with the increasing use of marginal kidneys, there has been a renewed interest into the use of hypothermic machine perfusion (HMP) [ 24 , 25 , 26 ]. The evidence suggests that HMP may be more beneficial in reducing delayed graft function (DGF) rates in marginal kidneys [ 27 ]. A recent study by Nath et al [ 28 ], comparing porcine kidneys’ metabolic profiles, suggested that beneficial effects exerted by HMP might be related to the removal of ROS.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Oxidative Stress and Metabolic Profile in a Preclinical Kidney Transplantation Model According to Different Preservation Modalities

Mrakic‐Sposta

Vezzoli

Cova

et al. 2023

IJMS

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This study addresses a joint nuclear magnetic resonance (NMR) and electron paramagnetic resonance (EPR) spectroscopy approach to provide a platform for dynamic assessment of kidney viability and metabolism. On porcine kidney models, ROS production, oxidative damage kinetics, and metabolic changes occurring both during the period between organ retrieval and implantation and after kidney graft were examined. The 1H-NMR metabolic profile—valine, alanine, acetate, trimetylamine-N-oxide, glutathione, lactate, and the EPR oxidative stress—resulting from ischemia/reperfusion injury after preservation (8 h) by static cold storage (SCS) and ex vivo machine perfusion (HMP) methods were monitored. The functional recovery after transplantation (14 days) was evaluated by serum creatinine (SCr), oxidative stress (ROS), and damage (thiobarbituric-acid-reactive substances and protein carbonyl enzymatic) assessments. At 8 h of preservation storage, a significantly (p < 0.0001) higher ROS production was measured in the SCS vs. HMP group. Significantly higher concentration data (p < 0.05–0.0001) in HMP vs. SCS for all the monitored metabolites were found as well. The HMP group showed a better function recovery. The comparison of the areas under the SCr curves (AUC) returned a significantly smaller (−12.5 %) AUC in the HMP vs. SCS. EPR-ROS concentration (μmol·g−1) from bioptic kidney tissue samples were significantly lower in HMP vs. SCS. The same result was found for the NMR monitored metabolites: lactate: −59.76%, alanine: −43.17%; valine: −58.56%; and TMAO: −77.96%. No changes were observed in either group under light microscopy. In conclusion, a better and more rapid normalization of oxidative stress and functional recovery after transplantation were observed by HMP utilization.

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Dynamic Parameters of Hypothermic Machine Perfusion—An Image of Initial Graft Function in Adult Kidney Transplantation?

Cited by 4 publications

References 25 publications

Acellular Perfusate is an Adequate Alternative to Packed Red Blood Cells During Normothermic Human Kidney Perfusion

Acellular Perfusate is an Adequate Alternative to Packed Red Blood Cells During Normothermic Human Kidney Perfusion

Perfusion Techniques in Kidney Allograft Preservation to Reduce Ischemic Reperfusion Injury: A Systematic Review and Meta-Analysis

Evaluation of Oxidative Stress and Metabolic Profile in a Preclinical Kidney Transplantation Model According to Different Preservation Modalities

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