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Subnormothermic Ex Vivo Porcine Kidney Perfusion Improves Energy Metabolism: Analysis Using 31 P Magnetic Resonance Spectroscopic Imaging.

Authors :
Agius T
Songeon J
Klauser A
Allagnat F
Longchamp G
Ruttimann R
Lyon A
Ivaniesevic J
Meier R
Déglise S
Markmann JF
Uygun K
Buhler L
Toso C
Corpataux JM
Lazeyras F
Longchamp A
Source :
Transplantation direct [Transplant Direct] 2022 Sep 26; Vol. 8 (10), pp. e1354. Date of Electronic Publication: 2022 Sep 26 (Print Publication: 2022).
Publication Year :
2022

Abstract

The ideal preservation temperature for donation after circulatory death kidney grafts is unknown. We investigated whether subnormothermic (22 °C) ex vivo kidney machine perfusion could improve kidney metabolism and reduce ischemia-reperfusion injury.<br />Methods: To mimic donation after circulatory death procurement, kidneys from 45-kg pigs underwent 60 min of warm ischemia. Kidneys were then perfused ex vivo for 4 h with Belzer machine perfusion solution UW at 22 °C or at 4 °C before transplantation. Magnetic resonance spectroscopic imaging coupled with LCModel fitting was used to assess energy metabolites. Kidney perfusion was evaluated with dynamic-contrast enhanced MRI. Renal biopsies were collected at various time points for histopathologic analysis.<br />Results: Total adenosine triphosphate content was 4 times higher during ex vivo perfusion at 22 °C than at 4 °C perfusion. At 22 °C, adenosine triphosphate levels increased during the first hours of perfusion but declined afterward. Similarly, phosphomonoesters, containing adenosine monophosphate, were increased at 22 °C and then slowly consumed over time. Compared with 4 °C, ex vivo perfusion at 22 °C improved cortical and medullary perfusion. Finally, kidney perfusion at 22 °C reduced histological lesions after transplantation (injury score: 22 °C: 10.5 ± 3.5; 4 °C: 18 ± 2.25 over 30).<br />Conclusions: Ex vivo kidney perfusion at 22°C improved graft metabolism and protected from ischemia-reperfusion injuries upon transplantation. Future clinical studies will need to define the benefits of subnormothermic perfusion in improving kidney graft function and patient's survival.<br />Competing Interests: The authors declare no conflicts of interest.<br /> (Copyright © 2022 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc.)

Details

Language :
English
ISSN :
2373-8731
Volume :
8
Issue :
10
Database :
MEDLINE
Journal :
Transplantation direct
Publication Type :
Academic Journal
Accession number :
36176724
Full Text :
https://doi.org/10.1097/TXD.0000000000001354