University Hospitals of Geneva, Geneva, Switzerland.
MAGMA. 2012 Oct;25(5):391-9. doi: 10.1007/s10334-012-0319-6. Epub 2012 May 29.
To demonstrate that adenosine triphosphate (ATP), which provides a valuable biomarker for kidney viability in the context of donation after cardiac death (DCD) transplantation, can be detected by means of (31)P magnetic resonance spectroscopy (MRS) if kidneys are perfused with oxygenated hypothermic pulsatile perfusion (O(2)+HPP).
Porcine kidney perfusion was carried out using a home made, MR-compatible HPP-machine. Consequently, kidney perfusion could be performed continuously during magnetic resonance imaging and magnetic resonance spectroscopy recording. (31)P MR spectroscopy consisted of 3-dimensional chemical shift imaging (CSI), which allowed for the detection of ATP level in line. (31)P CSI was performed at 3 tesla in 44 min with a nominal voxel size of 6.1 cc.
(31)P CSI enabled the detection of renal ATP when pO(2) was equal to 100 kPa. With pO(2) of 20 kPa, only phosphomonoester, inorganic phosphate and nicotinamide adenine dinucleotide could be found. Semi-quantitative analysis showed that ATP level was 1.3 mM in normal kidney perfused with pO(2) of 100 kPa.
This combined technology may constitute a new advance in DCD organ diagnostics prior to transplantation, as it allows direct assessment of ATP concentration, which provides a reliable indicator for organ bioenergetics and viability. In this study, kidneys presenting no warm ischemia were tested in order to establish values in normal organs. The test could be easily integrated into the clinical environment and would not generate any additional delay into the transplantation clinical workflow.
证明三磷酸腺苷（ATP）可作为心脏死亡后捐献（DCD）移植中肾脏活力的有价值的生物标志物，如果肾脏接受充氧低温搏动性灌注（O(2)+HPP），则可以通过（31）P 磁共振波谱（MRS）检测到。
使用自制的、与磁共振兼容的 HPP 机器进行猪肾灌注。因此，在磁共振成像和磁共振波谱记录期间，可以连续进行肾脏灌注。（31）P 磁共振波谱由 3 维化学位移成像（CSI）组成，可在线检测 ATP 水平。（31）P CSI 在 3 特斯拉下进行，共 44 分钟，标称体素大小为 6.1 cc。
当 pO(2)等于 100 kPa 时，（31）P CSI 可检测到肾 ATP。当 pO(2)为 20 kPa 时，只能检测到磷酸单酯、无机磷酸盐和烟酰胺腺嘌呤二核苷酸。半定量分析显示，用 pO(2)为 100 kPa 灌注的正常肾脏中 ATP 水平为 1.3 mM。
这项联合技术可能是 DCD 器官移植前诊断的新进展，因为它可以直接评估 ATP 浓度，这是器官生物能量学和活力的可靠指标。在这项研究中，测试了没有热缺血的肾脏，以确定正常器官的数值。该测试可以很容易地整合到临床环境中，并且不会给移植临床工作流程带来任何额外的延迟。
