Weegman B P, Kirchner V A, Scott W E, Avgoustiniatos E S, Suszynski T M, Ferrer-Fabrega J, Rizzari M D, Kidder L S, Kandaswamy R, Sutherland D E R, Papas K K
Schulze Diabetes Institute, University of Minnesota, Minneapolis, Minnesota, USA.
Transplant Proc. 2010 Jul-Aug;42(6):2020-3. doi: 10.1016/j.transproceed.2010.05.082.
Current ex vivo quality assessment of donor kidneys is limited to vascular resistance measurements and histological analysis. New techniques for the assessment of organ quality before transplantation may further improve clinical outcomes while expanding the depleted deceased-donor pool. We propose the measurement of whole organ oxygen consumption rate (WOOCR) as a method to assess the quality of kidneys in real time before transplantation.
Five porcine kidneys were procured using a donation after cardiac death (DCD) model. The renal artery and renal vein were cannulated and the kidney connected to a custom-made hypothermic machine perfusion (HMP) system equipped with an inline oxygenator and fiber-optic oxygen sensors. Kidneys were perfused at 8 degrees C, and the perfusion parameters and partial oxygen pressures (pO(2)) were measured to calculate WOOCR.
Without an inline oxygenator, the pO(2) of the perfusion solution at the arterial inlet and venous outlet diminished to near 0 within minutes. However, once adequate oxygenation was provided, a significant pO(2) difference was observed and used to calculate the WOOCR. The WOOCR was consistently measured from presumably healthy kidneys, and results suggest that it can be used to differentiate between healthy and purposely damaged organs.
Custom-made HMP systems equipped with an oxygenator and inline oxygen sensors can be applied for WOOCR measurements. We suggest that WOOCR is a promising approach for the real-time quality assessment of kidneys and other organs during preservation before transplantation.
目前对供体肾脏的体外质量评估仅限于血管阻力测量和组织学分析。移植前评估器官质量的新技术可能会进一步改善临床结果，同时扩大日益减少的脑死亡供体库。我们提出测量全器官氧消耗率（WOOCR）作为一种在移植前实时评估肾脏质量的方法。
使用心脏死亡后捐献（DCD）模型获取5个猪肾。将肾动脉和肾静脉插管，肾脏连接到配备在线氧合器和光纤氧传感器的定制低温机器灌注（HMP）系统。肾脏在8摄氏度下灌注，测量灌注参数和部分氧分压（pO(2)）以计算WOOCR。
在没有在线氧合器的情况下，动脉入口和静脉出口处灌注液的pO(2)在几分钟内降至接近0。然而，一旦提供足够的氧合，就会观察到显著的pO(2)差异并用于计算WOOCR。从可能健康的肾脏中持续测量WOOCR，结果表明它可用于区分健康器官和故意损伤的器官。
配备氧合器和在线氧传感器的定制HMP系统可用于WOOCR测量。我们认为WOOCR是一种在移植前保存期间对肾脏和其他器官进行实时质量评估的有前景的方法。
