Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
Department of Pathology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
Transplantation. 2019 Oct;103(10):2057-2064. doi: 10.1097/TP.0000000000002728.
Hypothermic machine perfusion (HMP) has become standard care in many center's to preserve kidneys donated after circulatory death (DCD). Despite a significant reduction in metabolism at low temperatures, the remaining cellular activity requires oxygen. Because of the role and safety of oxygen during HMP has not been fully clarified, its supply during HMP is not standard yet. This study investigates the effect of administering oxygen during HMP on renal function in a porcine DCD model.
After 30 minutes of warm ischemia, porcine slaughterhouse kidneys were preserved for 24 hours by means of cold storage (CS), or HMP with Belzer Machine Perfusion Solution supplemented with no oxygen, 21% or 100% oxygen. Next, kidneys were reperfused for 4 hours in a normothermic machine perfusion setup.
HMP resulted in significantly better kidney function during normothermic machine perfusion. Thiobarbituric acid-reactive substances, markers of oxidative stress, were significantly lower in HMP preserved kidneys. HMP preserved kidneys showed significantly lower aspartate aminotransferase and lactate dehydrogenase levels compared with kidneys preserved by CS. No differences were found between the HMP groups subjected to different oxygen concentrations. Adenosine triphosphate levels significantly improved during HMP when active oxygenation was applied.
This study showed that preservation of DCD kidneys with HMP is superior to CS. Although the addition of oxygen to HMP did not result in significantly improved renal function, beneficial effects were found in terms of reduced oxidative stress and energy status. Oxygen addition proofed to be safe and did not show detrimental effects.
低温机器灌注（HMP）已成为许多中心保存心跳死亡后捐献肾脏（DCD）的标准方法。尽管在低温下代谢显著降低，但剩余的细胞活动仍需要氧气。由于 HMP 期间氧气的作用和安全性尚未完全阐明，因此其在 HMP 期间的供应尚未标准化。本研究旨在调查 HMP 期间供氧对猪 DCD 模型肾功能的影响。
在 30 分钟的热缺血后，通过冷储存（CS）或 HMP 用 Belzer 机器灌注液保存猪屠宰场肾脏 24 小时，该灌注液中不添加氧气、21%或 100%氧气。然后，在常温机器灌注装置中对肾脏进行 4 小时再灌注。
HMP 在常温机器灌注期间显著改善了肾脏功能。氧化应激标志物硫代巴比妥酸反应物质在 HMP 保存的肾脏中显著降低。与 CS 保存的肾脏相比，HMP 保存的肾脏中天冬氨酸转氨酶和乳酸脱氢酶水平显著降低。在接受不同氧浓度的 HMP 组之间未发现差异。当进行活性氧合时，HMP 期间三磷酸腺苷水平显著改善。
本研究表明，HMP 保存 DCD 肾脏优于 CS。尽管向 HMP 中添加氧气并未导致肾功能显著改善，但在降低氧化应激和能量状态方面发现了有益的效果。氧气添加被证明是安全的，没有显示出有害影响。
