Continuous Normothermic Ex Vivo Kidney Perfusion Is Superior to Brief Normothermic Perfusion Following Static Cold Storage in Donation After Circulatory Death Pig Kidney Transplantation

• Published in: American journal of transplantation Vol. 17; no. 4; pp. 957 - 969
• Main Authors: Kaths, J. M., Cen, J. Y., Chun, Y. M., Echeverri, J., Linares, I., Ganesh, S., Yip, P., John, R., Bagli, D., Mucsi, I., Ghanekar, A., Grant, D. R., Robinson, L. A., Selzner, M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Limited 01-04-2017
• Subjects: animal models: porcine; Animals; autotransplantation; basic (laboratory) research/science; Brain Death; Cold Temperature; donors and donation: donation after circulatory death (DCD); Kidney Transplantation - methods; kidney transplantation/nephrology; Male; organ perfusion and preservation; Organ Preservation - methods; organ transplantation in general; Perfusion; regenerative medicine; Sus scrofa; Tissue and Organ Harvesting - methods; Tissue and Organ Harvesting - standards; Tissue and Organ Procurement; tissue injury and repair; translational research/science; translational research/science; organ transplantation in general; kidney transplantation/nephrology; regenerative medicine; tissue injury and repair; autotransplantation; donors and donation: donation after circulatory death (DCD); animal models: porcine; basic (laboratory) research/science; organ perfusion and preservation
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/ajt.14059

Hypothermic preservation is known to cause renal graft injury, especially in donation after circulatory death (DCD) kidney transplantation. We investigated the impact of cold storage (SCS) versus short periods of normothermic ex vivo kidney perfusion (NEVKP) after SCS versus prolonged, continuous NEVKP with near avoidance of SCS on kidney function after transplantation. Following 30 min of warm ischemia, kidneys were removed from 30‐kg Yorkshire pigs and preserved for 16 h with (A) 16 h SCS, (B) 15 h SCS + 1 h NEVKP, (C) 8 h SCS + 8 h NEVKP, and (D) 16 h NEVKP. After contralateral kidney resection, grafts were autotransplanted and pigs followed up for 8 days. Perfusate injury markers such as aspartate aminotransferase and lactate dehydrogenase remained low; lactate decreased significantly until end of perfusion in groups C and D (p < 0.001 and p = 0.002). Grafts in group D demonstrated significantly lower serum creatinine peak when compared to all other groups (p < 0.001) and 24‐h creatinine clearance at day 3 after surgery was significantly higher (63.4 ± 19.0 mL/min) versus all other groups (p < 0.001). Histological assessment on day 8 demonstrated fewer apoptotic cells in group D (p = 0.008). In conclusion, prolonged, continuous NEVKP provides superior short‐term outcomes following DCD kidney transplantation versus SCS or short additional NEVKP following SCS.
In a model of donation after circulatory death pig kidney autotransplantation, complete exclusion of cold ischemia using continuous normothermic ex vivo kidney perfusion demonstrates superior posttransplant outcomes versus brief normothermic ex vivo kidney perfusion following static cold storage.