Urbanellis Peter, Kollmann Dagmar, Linares Ivan, Ganesh Sujani, Oquendo Fabiola, Mazilescu Laura, Goto Toru, Noguchi Yuki, John Rohan, Konvalinka Ana, Mucsi Istvan, Ghanekar Anand, Bagli Darius, Selzner Markus, Robinson Lisa A
Multi-Organ Transplant Program, Department of Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada.
Transplant Direct. 2020 Jul 22;6(8):e587. doi: 10.1097/TXD.0000000000001030. eCollection 2020 Aug.
Normothermic ex vivo kidney perfusion (NEVKP) is an emerging technique for renal graft preservation. We investigated whether NEVKP could improve early function of severely injured grafts and reduce the incidence of significant renal dysfunction (SRD) similar to delayed graft function in a model of donation after circulatory death.
Kidneys from 30-kg Yorkshire pigs were removed following 120 minutes of warm ischemia (WI). These grafts were then preserved in static cold storage (SCS, n = 6) or subjected to NEVKP (n = 5) for 8 hours before heterotopic autotransplantation. SRD was defined as postoperative day (POD) 4 oliguria <500 mL/24 h with serum K +> 6.0 mmol/L.
All 4 surviving animals with 120 minutes WI grafts stored with SCS developed SRD, compared with 1/5 in the NEVKP group ( = 0.02). The NEVKP group, when compared with SCS, also demonstrated significantly decreased serum creatinine peak values (1118.51 ± 206.90 µmol/L versus 1675.56 ± 98.15 µmol/L; = 0.002) and higher creatinine clearance (POD4: 9.05 ± 6.97 mL/min versus 0.89 ± 0.56 mL/min; = 0.05). By POD7, serum creatinine was not significantly different than baseline in the NEVKP (431.49 ± 492.50 µmol/L versus 90.19 ± 14.15 µmol/L, respectively; = 0.20) but remained elevated following SCS (1189.25 ± 309.47 µmol/L versus 97.26 ± 29.18 µmol/L, respectively; < 0.01). Histology demonstrated significantly decreased tubular injury scores compared with SCS grafts ( = 0.03).
Kidney grafts subjected to 120 minutes WI before retrieval showed significant improvement in function, prevention of SRD, and decreased injury following 8 hours of NEVKP.
常温离体肾灌注（NEVKP）是一种新兴的肾移植保存技术。我们研究了在循环死亡后捐赠模型中，NEVKP是否能改善严重损伤移植物的早期功能，并降低与延迟移植肾功能类似的严重肾功能障碍（SRD）的发生率。
30千克约克夏猪的肾脏在经历120分钟热缺血（WI）后被取出。然后将这些移植物在静态冷藏（SCS，n = 6）中保存或在异位自体移植前接受NEVKP（n = 5）8小时。SRD定义为术后第4天少尿<500 mL/24小时且血清钾+> 6.0 mmol/L。
所有4只存活的接受120分钟WI并采用SCS保存移植物的动物均发生了SRD，而NEVKP组为1/5（P = 0.02）。与SCS相比，NEVKP组还显示血清肌酐峰值显著降低（1118.51±206.90 µmol/L对1675.56±98.15 µmol/L；P = 0.002）以及肌酐清除率更高（术后第4天：9.05±6.97 mL/分钟对0.89±0.56 mL/分钟；P = 0.05）。到术后第7天，NEVKP组血清肌酐与基线无显著差异（分别为431.49±492.50 µmol/L对90.19±14.15 µmol/L；P = 0.20），但SCS后仍升高（分别为1189.25±309.47 µmol/L对97.26±29.18 µmol/L；P < 0.01）。组织学显示与SCS移植物相比，肾小管损伤评分显著降低（P = 0.03）。
在取回前经历120分钟WI的肾移植物在8小时NEVKP后功能有显著改善，预防了SRD，并减少了损伤。
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