Lignell Stina, Lohmann Stine, Rozenberg Kaithlyn M, Leuvenink Henri G D, Pool Merel B F, Lewis Kate R, Moers Cyril, Hunter James P, Ploeg Rutger J, Eijken Marco, Møldrup Ulla, Krag Søren, Baan Carla C, Møller Bjarne Kuno, Keller Anna Krarup, Jespersen Bente
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark.
Transplant Direct. 2021 Jan 15;7(2):e653. doi: 10.1097/TXD.0000000000001108. eCollection 2021 Feb.
In an era where global kidney shortage has pushed the field of transplantation towards using more marginal donors, modified kidney preservation techniques are currently being reviewed. Some techniques require further optimization before implementation in full scale transplantation studies. Using a porcine donation after circulatory death kidney model, we investigated whether initial kidney hemodynamics improved during normothermic machine perfusion if this was preceded by a short period of oxygenated hypothermic machine perfusion (oxHMP) rather than static cold storage (SCS).
Kidneys subjected to 75 minutes of warm ischemia were randomly assigned to either SCS (n = 4) or SCS + oxHMP (n = 4), with a total cold storage time of 240 minutes. Cold preservation was followed by 120 minutes of normothermic machine perfusion with continuous measurement of hemodynamic parameters and renal function.
oxHMP preserved kidneys maintained significantly lower renal resistance throughout the normothermic machine perfusion period compared to SCS kidneys ( < 0.001), reaching lowest levels at 60 minutes with means of 0.71 ± 0.35 mm Hg/mL/min/100 g (SCS) and 0.45 ± 0.15 mm Hg/mL/min/100 g (oxHMP). Accordingly, the oxHMP group had a higher mean renal blood flow versus SCS kidneys ( < 0.001). oxHMP kidneys had higher oxygen consumption during normothermic machine perfusion compared to SCS preserved kidneys ( < 0.001). Creatinine clearance remained similar between groups ( = 0.665).
Preceding oxHMP significantly improved initial normothermic machine perfusion hemodynamics and increased total oxygen consumption. With the long period of warm ischemia, immediate kidney function was not observed, reflected by the findings of low creatinine clearance in both groups.
在全球肾脏短缺促使移植领域更多地使用边缘供体的时代，目前正在对改良的肾脏保存技术进行评估。一些技术在全面应用于移植研究之前需要进一步优化。我们使用心脏死亡后捐献的猪肾模型，研究了在常温机器灌注之前先进行短时间的氧合低温机器灌注（oxHMP）而非静态冷藏（SCS）是否能改善肾脏的初始血流动力学。
将经历75分钟热缺血的肾脏随机分为SCS组（n = 4）或SCS + oxHMP组（n = 4），总冷藏时间为240分钟。冷藏后进行120分钟的常温机器灌注，持续测量血流动力学参数和肾功能。
与SCS组肾脏相比，oxHMP组保存的肾脏在整个常温机器灌注期间的肾阻力显著更低（<0.001），在60分钟时达到最低水平，平均值分别为0.71±0.35 mmHg/mL/min/100g（SCS）和0.45±0.15 mmHg/mL/min/100g（oxHMP）。因此，oxHMP组的平均肾血流量高于SCS组肾脏（<0.001）。与SCS保存的肾脏相比，oxHMP组肾脏在常温机器灌注期间的氧消耗量更高（<0.001）。两组之间的肌酐清除率保持相似（=0.665）。
先进行oxHMP可显著改善初始常温机器灌注的血流动力学并增加总氧消耗量。由于热缺血时间较长，两组肌酐清除率均较低，未观察到即刻肾功能。
