Department of Surgery - Organ Donation and Transplantation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Artif Organs. 2024 Jun;48(6):595-605. doi: 10.1111/aor.14705. Epub 2024 Jan 1.
Normothermic machine perfusion (NMP) is a promising pretransplant kidney quality assessment platform, but it remains crucial to increase its diagnostic potential while ensuring minimal additional injury to the already damaged kidney. Interventions that alter tubular transport can influence renal function and injury during perfusion. This study aimed to determine whether furosemide and desmopressin affect renal function and injury during NMP.
Eighteen porcine kidneys (n = 6 per group) were subjected to 30 min of warm ischemia and 4 h of oxygenated hypothermic perfusion before being subjected to 6 h of NMP. Each organ was randomized to receive no drug, furosemide (750 mg), or desmopressin (16 μg) during NMP.
Compared with the other groups, the addition of furosemide resulted in significantly increased urine output, fractional excretion of sodium and potassium, and urea clearance during NMP. Urinary neutrophil gelatinase-associated lipocalin levels decreased significantly with furosemide supplementation compared with the other groups. The addition of desmopressin did not result in any significantly different outcome measurements compared with the control group.
This study showed that the addition of furosemide affected renal function while attenuating tubulointerstitial injury during NMP. Therefore, furosemide supplementation may provide renal protection and serve as a functional test for pretransplant kidney viability assessment during NMP.
常温机器灌注（NMP）是一种很有前途的移植前肾脏质量评估平台，但仍然需要增加其诊断潜力，同时确保对已经受损的肾脏造成最小的额外损伤。改变管状转运的干预措施会影响灌注期间的肾功能和损伤。本研究旨在确定呋塞米和去氨加压素是否会影响 NMP 期间的肾功能和损伤。
18 个猪肾（每组 6 个）在经历 30 分钟的热缺血和 4 小时的充氧低温灌注后，进行 6 小时的 NMP。每个器官在 NMP 期间随机接受不给予药物、呋塞米（750mg）或去氨加压素（16μg）。
与其他组相比，在 NMP 期间添加呋塞米可显著增加尿量、钠和钾的分数排泄和尿素清除率。与其他组相比，呋塞米补充后尿中性粒细胞明胶酶相关脂质运载蛋白水平显著降低。与对照组相比，添加去氨加压素没有导致任何明显不同的结果测量。
本研究表明，呋塞米的添加影响了肾功能，同时减轻了 NMP 期间的肾小管间质损伤。因此，呋塞米补充可能提供肾脏保护，并作为 NMP 期间移植前肾脏活力评估的功能测试。
