Normothermic Versus Hypothermic Ex Vivo Flush Using a Novel Phosphate-Free Preservation Solution (AQIX) in Porcine Kidneys

Kay, Mark; Hosgood, Sarah A.; Harper, S.; Bagul, Atul; Waller, Helen; Nicholson, Michael L.

doi:10.1016/j.jss.2010.01.018

Cited by 25 publications

(22 citation statements)

References 29 publications

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“…19, 20 GALA, as the most widely recognized of these solutions, was used for physiologic characterization along with more traditional solutions. GALA contains glutathione and L-ascorbic acid, antioxidants, and arginine, a substrate for nitric oxide synthase in endothelial cells, which were added to a buffered electrolyte solution.…”

Section: Discussionmentioning

confidence: 99%

Preservation solution impacts physiologic function and cellular viability of human saphenous vein graft

Wise

Hocking

Eagle

et al. 2015

Surgery

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Introduction Recent clinical data suggests intraoperative preservation of human saphenous vein (HSV) in normal saline is associated with vein graft failure. We evaluated the influence of several preservation media on acute physiologic function and cellular viability of HSV conduit. Methods Unprepared (UP) HSV obtained from coronary artery bypass graft patients was characterized on a muscle bath after two hour storage in Plasma-Lyte A, normal saline, University of Wisconsin solution, Celsior solution, autologous whole blood, or glutathione-ascorbic acid- L-arginine (GALA) solution. Vascular smooth muscle contractility to depolarizing KCl and phenylephrine was assessed. The relaxation of phenylephrine-pre-contracted HSV to sodium nitroprusside and carbachol (endothelial-independent and -dependent relaxation, respectively) was also assessed. Cellular viability was determined via the methyl thiazolyl tetrazolium (MTT) assay. Rat aortae were used to assess the effect of pH during graft preservation on endothelial-dependent relaxation. Results Preservation of HSV in normal saline and autologous whole blood impaired contractile responses to KCl relative to UP tissues, while University of Wisconsin solution and Celsior solution preservation enhanced contractile responses (P<.05). Relative to UP tissues, responses to phenylephrine were decreased with preservation in normal saline, while preservation in University of Wisconsin solution, Celsior solution and GALA all potentiated these responses (P<.05). Only normal saline preservation impaired endothelial-independent relaxation (P=.005). Preservation in Plasma-Lyte A (P=.02), normal saline (P=.002) and University of Wisconsin solution (P=.02) led to impaired endothelial-dependent relaxation. Normal saline preservation led to a decreased MTT viability index relative to UP tissues (0.021±0.002 mg−10.5 mL−1 vs. 0.033±0.005 mg−10.5 mL−1; P=.03). Endothelial function was impaired by acidic pH in rat aorta. Conclusions Normal saline preservation causes graft injury leading to impaired physiologic function and decreased viability of HSV. This harm to the conduit is mitigated by the use of buffered salt solutions as preservation media.

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Section: Discussionmentioning

confidence: 99%

Preservation solution impacts physiologic function and cellular viability of human saphenous vein graft

Wise

Hocking

Eagle

et al. 2015

Surgery

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“…Applying this principle in terms of multiorgan procurement, there is an enormous loss of blood volume due to incision of the vena cava and a loss of vessel tonus due to the occurrence of brain death. In contrast, the resistance inside the kidney circulation is increased due to vasoconstriction of RA induced by hypothermia [14]. These effects result in a loss of mean cardiovascular pressure, which has to be outweighed by the perfusate flow.…”

Section: Discussionmentioning

confidence: 99%

Comparative analysis of in situ versus ex situ perfusion on flow and microcirculation in kidney procurement: research on a porcine model

et al. 2013

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BackgroundThe first crucial step in transplantation appears to be the effective rinsing of the graft during organ procurement. Even though there is strong suspicion that ex situ perfusion results in better rinsing of the graft, there is no proof for this hypothesis. The aim of this study was to analyse the differences of in situ and ex situ kidney perfusion in a porcine model.MethodsStandardised multiorgan procurement was performed in 15 German landrace pigs. Perfusion was carried out using histidine–tryptophan–ketoglutarate solution (HTK) under the application of pressure. In one kidney, in situ perfusion via the aorta was carried out while the second kidney received ex situ perfusion via the renal artery (RA). Perfusate flow inside the aorta and the RA was recorded at different pressure steps. In order to visualise the effect on the microcirculation, different coloured microparticles (MPs; 10 μm) were administered via the aorta or RA. Subsequently, frozen sections of the explanted kidneys were analysed histologically and MPs were evaluated quantitatively.ResultsEx situ kidney perfusion resulted in significantly improved flow rates (P<0.0001) compared with in situ perfusion. By applying ex situ perfusion it was even possible to attain physiological flow levels on the RA under the application of external pressure of 150 to 200 mmHg. The amount of MPs was able to highlight the positive impact of ex situ perfusion on microcirculation of the kidney graft (P<0.0001).ConclusionsThe use of MPs represents a valuable tool for quantitative investigation and illustration of kidney perfusion in experimental setups. Additional ex situ perfusion is able to improve the quality of kidney perfusion.

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“…AQIX is a solution mimicking physiological serum conditions with an N,N-bis(2-hydroxyethyl)-2-aminoethanesulfonic acid (BES)-hydrogen carbonate pH buffering system which shows a buffering capacity over a large range of temperatures from hypo- to normothermia and can thus also be used in quite a warm environment [8]. …”

Section: Cold Storage Solutionsmentioning

confidence: 99%

New Strategies and Concepts in Organ Preservation

Hoffmann

Minor²

2014

Eur Surg Res

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Organ transplantation is still affected by a notable degree of preservation-associated ischemia and reperfusion injury, which can seriously hamper early graft function. The increasing extension of the criteria for donor organ acceptance, especially for organs that have suffered from periods of warm ischemic injury prior to graft retrieval, results in even higher demands on preserving these ischemia-sensitive grafts. Growing attention is thus directed towards more dynamic preservation methods instead of simple static storage. Particularly in grafts that are retrieved after cardiac standstill of the donor, provision of oxygen to enable some kind of regenerative metabolism appears to be desirable, although the optimal temperature for oxygenated preservation/revitalization is still under debate. Hybrid solutions, comprising conventional cold storage for ease of graft procurement and transportation together with more sophisticated ‘in-house' reconditioning protocols after arrival at the implantation clinic, might help to minimize graft injury during the critical transition from preservation to reperfusion. © 2014 S. Karger AG, Basel

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Normothermic Versus Hypothermic Ex Vivo Flush Using a Novel Phosphate-Free Preservation Solution (AQIX) in Porcine Kidneys

Cited by 25 publications

References 29 publications

Preservation solution impacts physiologic function and cellular viability of human saphenous vein graft

Preservation solution impacts physiologic function and cellular viability of human saphenous vein graft

Comparative analysis of in situ versus ex situ perfusion on flow and microcirculation in kidney procurement: research on a porcine model

New Strategies and Concepts in Organ Preservation

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