Exsanguinous Metabolic Support Perfusion???a New Strategy to Improve Graft Function After Kidney Transplantation1

Abstract

The results demonstrate a reduction of reperfusion damage by an acellular ex vivo restoration of renal metabolism. Furthermore, data from the contralateral kidneys substantiates the relative role of WI on metabolism in renal transplantation.

NOS: The Underlying Mechanism Preserving Vascular Integrity and During Ex Vivo Warm Kidney Perfusion

“…Exsanguineous metabolic support (EMS) technology (Breonics Inc., Schenectady, NY) was used for ex vivo warm perfusion (32 C); a temperature range previously shown to adequately support oxidative metabolism and cellular reparative processes (18)(19)(20)(21)(22)(23)(24). Both human and canine kidneys were placed on a perfusion system including an oxygenator and a pulsatile pump, retrofitted with controllers to maintain PAO 2 , PACO 2 , pH and temperature.…”

Normothermic Ex Vivo Kidney Perfusion Following Static Cold Storage—Brief, Intermediate, or Prolonged Perfusion for Optimal Renal Graft Reconditioning?

“…Brasile and Stubenitsky et al investigated subnormothermic kidney machine perfusion at near-physiologic temperatures in the 2000s (26)(27)(28)(29). In one study, canine kidneys were recovered following 30 min of WI and were subjected to 18 h SCS at 4°C, warm perfusion at 32°C with exsanguinous metabolic support (EMS) for 18 h, or combinations of both.…”

A Pilot Study Assessing the Feasibility of a Short Period of Normothermic Preservation in an Experimental Model of Non Heart Beating Donor Kidneys

“…Alternatives that have suitable oxygen carriage and delivery properties include perfluorocarbons [24] and artificial hemoglobin solutions [5], but more research will be required to assess their role. Brasile et al have used an acellular solution containing tissue culture medium to extend reversible warm ischemic time to 2 h in canine kidneys [25]; further development of this technology is awaited.…”

“…Much shorter periods of normothermic preservation after ischemic damage have also been found to be beneficial in renal transplantation. Brasile et al used a brief period of normothermic preservation using an acellular perfusate to reduce reperfusion damage in a canine autotransplant model [5]. Restoring metabolism after ischemia and before transplantation in this manner may also provide a more genuine assessment of organ viability than is currently afforded by hypothermic techniques.…”