Lantinga Veerle A, Arykbaeva Asel S, Spraakman Nora A, Blom Elwin W P, Huijink Tobias M, de Vries Dorottya K, Ploeg Rutger J, Alwayn Ian P J, Leuvenink Henri G D, Moers Cyril, van Leeuwen L Leonie
Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands.
Artif Organs. 2025 Jan;49(1):93-107. doi: 10.1111/aor.14851. Epub 2024 Aug 28.
A growing interest in renal normothermic machine perfusion (NMP) has resulted in more clinically available perfusion devices. While all perfusion systems have the same aim, there are significant differences in their circuits, pumps, sensors, and software. Therefore, our objective was to assess the impact of different perfusion protocols and devices on kidney function and perfusion parameters during NMP.
Porcine kidneys were subjected to 30 min of warm ischemia, 24 h of static cold storage, and subsequently perfused for 6 h using (1) the Kidney Assist (KA) machine with a pressure of 75 mm Hg, (2) the KA device incorporating several adjustments and a pressure of 85 mm Hg (modified KA), or (3) the Perlife (PL) perfusion device (n = 4). Consecutively, discarded human kidneys were perfused using the KA or modified KA (n = 3) protocol.
The PL group quickly reached the device's upper flow limit and consequently received a significantly lower pressure compared to the KA groups. The arterial pO was significantly lower in the PL group. Yet, hemoglobin concentration increased over time, and oxygen consumption was significantly higher compared to the KA groups. Fractional sodium excretion was significantly lower in the PL group. Tissue ATP levels, urine production, and creatinine clearance rates did not differ between groups. In human kidneys, the modified KA group showed significantly lower vascular resistance, higher oxygen delivery, and lower levels of lactate in the perfusate compared to the KA group.
This study shows that perfusion characteristics and kidney function are significantly influenced by the perfusion protocol and the device and its settings during normothermic machine perfusion and therefore should be interpreted with caution.
对肾脏常温机器灌注（NMP）的兴趣日益浓厚，导致临床上有更多可用的灌注设备。虽然所有灌注系统都有相同的目标，但它们的回路、泵、传感器和软件存在显著差异。因此，我们的目的是评估不同灌注方案和设备对NMP期间肾功能和灌注参数的影响。
将猪肾进行30分钟的热缺血、24小时的静态冷藏，随后使用以下方法灌注6小时：（1）Kidney Assist（KA）机器，压力为75毫米汞柱；（2）进行了多项调整且压力为85毫米汞柱的KA设备（改良KA）；或（3）Perlife（PL）灌注设备（n = 4）。随后，使用KA或改良KA方案对废弃的人肾进行灌注（n = 3）。
与KA组相比，PL组很快达到设备的流量上限，因此接受的压力显著更低。PL组的动脉血氧分压显著更低。然而，血红蛋白浓度随时间增加，且与KA组相比，氧耗显著更高。PL组的钠排泄分数显著更低。各组之间的组织三磷酸腺苷水平、尿量和肌酐清除率没有差异。在人肾中，与KA组相比，改良KA组的血管阻力显著更低，氧输送更高，灌注液中的乳酸水平更低。
本研究表明，在常温机器灌注期间，灌注方案、设备及其设置会显著影响灌注特征和肾功能，因此应谨慎解读。
