Static normothermic preservation of renal allografts using a novel nonphosphate buffered preservation solution

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

doi:10.1111/j.1432-2277.2006.00390.x

Cited by 29 publications

(12 citation statements)

References 13 publications

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“…The perfusion solution used in this study—Aqix RSI—has already been proposed as useful medium for flush and static preservation of kidneys at 30 °C . However, the results of the present study argue in favor of a cold flush to protect the organ during the second warm ischemia in the setting of engraftment.…”

Section: Discussionmentioning

confidence: 74%

Cold flush after dynamic liver preservation protects against ischemic changes upon reperfusion - an experimental study

et al. 2018

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Summary Ex vivo machine perfusion of the liver after cold storage has found to be most effective if combined with controlled oxygenated rewarming up to (sub)‐normothermia. On disconnection of the warm graft from the machine, most surgeons usually perform a cold flush of the organ as protection against the second warm ischemia incurred upon implantation. Experimental evidence, however, is lacking and protective effect of deep hypothermia has been challenged for limited periods of liver ischemia in other models. A first systematic test was carried out on porcine livers, excised 30 min after cardiac arrest, subjected to 18 h of cold storage in UW and then machine perfused for 90 min with Aqix‐RSI solution. During machine perfusion, livers were gradually rewarmed up to 20 °C. One group (n = 6) was then reflushed with 4 °C cold Belzer UW solution whereas the second group (n = 6) remained without cold flush. All livers were exposed to 45 min warm ischemia at room temperature to simulate the surgical implantation period. Organ function was evaluated in an established reperfusion model using diluted autologous blood. Cold reflush after disconnection from the machine resulted in a significant increase in bile production upon blood reperfusion, along with a significant reduction in transaminases release alanine aminotransferase and of the intramitochondrial enzyme glutamate dehydrogenase. Interestingly, free radical‐mediated lipid peroxidation was also found significantly lower after cold reflush. No differences between the groups could be evidenced concerning histological injury and recovery of hepatic energy metabolism (tissue content of adenosine triphosphate). Post‐machine preservation cold reflush seems to be beneficial in this particular setting, even if the organs are warmed up only to 20 °C, without notion of adverse effects, and should therefore be implemented in the protocol.

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Section: Discussionmentioning

confidence: 74%

Cold flush after dynamic liver preservation protects against ischemic changes upon reperfusion - an experimental study

et al. 2018

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“…We have shown that porcine kidneys flushed with pre‐oxygenated AQIX‐RS‐I at 32 °C adequately cleared the microcirculation with no detrimental effects . It is also capable of maintaining cellular integrity under static storage conditions for up to 2 h at 32 °C .…”

Section: Normothermic Perfusion – Artificial Preservation Conditionsmentioning

confidence: 90%

Normothermic machine perfusion of the kidney: better conditioning and repair?

2014

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Summary Kidney transplantation is limited by hypothermic preservation techniques. Prolonged periods of cold ischaemia increase the risk of early graft dysfunction and reduce long‐term survival. To extend the boundaries of transplantation and utilize kidneys from more marginal donors, improved methods of preservation are required. Normothermic perfusion restores energy levels in the kidney allowing renal function to be restored ex vivo. This has several advantages: cold ischaemic injury can be avoided or minimized, the kidney can be maintained in a stable state allowing close observation and assessment of viability and lastly, it provides the ideal opportunity to add therapies to directly manipulate and improve the condition of the kidney. This review explores the experimental and clinical evidence for ex vivo normothermic perfusion in kidney transplantation and its role in conditioning and repair.

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“…Aqix RS‐I is a novel extracellular‐type solution, which has the capability to maintain pH stability over a wide temperature range and has proven an appropriate preservation solution up to normothermic conditions …”

Section: Introductionmentioning

confidence: 99%

“…Aqix RS-I is a novel extracellular-type solution, which has the capability to maintain pH stability over a wide temperature range and has proven an appropriate preservation solution up to normothermic conditions. 12 This study thus was designed to compare the suitability of liver reconditioning by COR up to varying temperatures (20°C and 35°C) by machine perfusion. The potential and optimal regeneration conditions for damaged livers by short-term preimplantation ex vivo liver perfusion were evaluated.…”

mentioning

confidence: 99%

Controlled oxygenated rewarming up to normothermia for pretransplant reconditioning of liver grafts

Horn

Baba

Hannaert

et al. 2017

Clinical Transplantation

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Controlled oxygenated rewarming (COR) up to 20°C during ex vivo machine perfusion limits reperfusion-induced tissue injury upon graft implantation. Rewarming up to normothermia might add further benefits and provide better prediction of posttransplantation organ function. The effect of 90 minutes of oxygenated machine perfusion with Aqix RS-I after cold storage combined with gentle rewarming up to 20°C (COR20) or 35°C (COR35) was studied in rat livers and compared with cold storage alone (CS, n = 6, resp). Postpreservation recovery was evaluated upon warm reperfusion using an established in vitro system. COR generally resulted in significantly improved energetic recovery, increased bile flow, less activities alanine aminotransferase (ALT) release, and improved histopathology upon reperfusion as compared to only cold-stored livers, without significant differences between COR20 and COR35.Parameters obtained during COR, especially during COR35, also allowed for prediction of hepatic recovery upon reperfusion. For instance, ulterior bile production upon reperfusion was found closely correlated to bile flow observed already during COR35 (R 2 = 0.91). COR significantly improved liver quality after static cold storage. Elevation of machine perfusion temperature up to 35°C may prove promising to refine ex vivo evaluation of the graft prior to transplantation. K E Y W O R D Scontrolled oxygenated rewarming, liver preservation, machine perfusion, organ reconditioning | INTRODUCTIONOne of the major restrictions in transplantation medicine is the limited number of available donor organs. Due to this imbalance between donor organs and waiting recipients, the criteria of organ selection were extended and grafts of lesser quality became increasingly accepted to be transplanted. 1 The use of these "less-than-optimal" grafts provides new challenges in transplantation research with regard to organ preservation and conditioning. 2 New ex vivo strategies for maintenance and improvement of organ function could prevent storage and reperfusion-induced tissue injury and could therefore result in decreased post-transplantation graft dys-or nonfunction. 3Organ preservation traditionally includes flush-out with appropriate preservation solutions followed by cold storage under hypoxic conditions. 4 Problems associated with this technique are hypoxiainduced apoptotic events as well as activation of pro-inflammatory mediators, which influence post-transplantation organ function and integrity. 5 Previous research evidenced that main destructive effects rather establish during exposure of organs to blood circulation after implantation than during the ischemic cold storage period itself. 6This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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Static normothermic preservation of renal allografts using a novel nonphosphate buffered preservation solution

Cited by 29 publications

References 13 publications

Cold flush after dynamic liver preservation protects against ischemic changes upon reperfusion - an experimental study

Cold flush after dynamic liver preservation protects against ischemic changes upon reperfusion - an experimental study

Normothermic machine perfusion of the kidney: better conditioning and repair?

Controlled oxygenated rewarming up to normothermia for pretransplant reconditioning of liver grafts

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