Prudhomme Thomas, Darius Tom, Levy Stephan, Loiseau Emma, Le Bas-Bernardet Stéphanie, Hervouet Jérémy, Minault David, Blancho Gilles, Bruneau Sarah, Badet Lionel, Kron Philipp, Mesnard Benoit, Branchereau Julien
Nantes Université, CHU Nantes, INSERM, Centre for Research in Transplantation and Translational Immunology, Nantes, France.
Surgery and Abdominal Transplant Unit, University Clinics Saint Luc, Université Catholique de Louvain, Brussels, Belgium.
Artif Organs. 2025 Apr;49(4):600-614. doi: 10.1111/aor.14916. Epub 2024 Dec 6.
Preclinical and clinical studies have demonstrated the advantages of oxygenated hypothermic machine perfusion (HMPO) during kidney preservation. However, the optimal oxygenation levels during HMPO remain undetermined. The aim of this study was to compare different levels of oxygenation (0%, 21%, 50%, and 100%) during 22 h of active oxygenated HMP (HMPO) using oxygen preloading by bubbling oxygenation in the preservation solution and continuous surface oxygenation during MP in a porcine DCD model.
After 60 min of warm ischemia time, both kidneys of an 80 kg pig were procured and randomized to one of the following groups: (1) 22-h static cold storage (n = 6), (2) 22-h HMP without active oxygenation (n = 6), (3) 22-h HMPO 21% O (n = 6), (4) 22-h HMPO 50% O (n = 6), and (5) 22-h HMPO 100% O (n = 6). The primary outcome measure was to compare the different oxygen levels among the different groups assessed by cortex kidney tissue oxygen partial pressures (tpO).
Continuous HMPO resulted in a significant modification of cortex kidney tpO. In addition, tpO was dependent on the percentage of oxygenation. One hundred percent oxygen resulted in a significantly higher tpO compared to all other study groups. In line with that, ATP resynthesis was significantly higher in the HMPO 100% group.
This study demonstrates that continuous HMPO results in a significant modification of tpO compared with SCS, and the degree of tpO is positively correlated with the percentage of active oxygenation during HMP. Metabolic profile analyses (ATP resynthesis) suggest that the aerobic mechanism is better supported with higher oxygen levels (50% and 100% oxygenation).
临床前和临床研究已证明在肾脏保存过程中氧合低温机器灌注（HMPO）的优势。然而，HMPO期间的最佳氧合水平仍未确定。本研究的目的是在猪的心脏死亡后捐赠（DCD）模型中，通过在保存溶液中鼓泡氧合进行氧预加载以及在机器灌注期间进行持续表面氧合，比较在22小时的活性氧合HMP（HMPO）期间不同的氧合水平（0%、21%、50%和100%）。
在经历60分钟的热缺血时间后，获取一头80公斤猪的双肾，并随机分为以下组之一：（1）22小时静态冷藏（n = 6），（2）22小时无活性氧合的HMP（n = 6），（3）22小时21%氧的HMPO（n = = 6），（4）22小时50%氧的HMPO（n = 6），以及（5）22小时100%氧的HMPO（n = 6）。主要结局指标是通过肾皮质组织氧分压（tpO）比较不同组之间的不同氧水平。
持续的HMPO导致肾皮质tpO发生显著改变。此外，tpO取决于氧合百分比。与所有其他研究组相比，100%氧导致tpO显著更高。与此一致，100% HMPO组的ATP再合成显著更高。
本研究表明，与静态冷藏相比，持续的HMPO导致tpO发生显著改变，并且tpO的程度与HMP期间活性氧合的百分比呈正相关。代谢谱分析（ATP再合成）表明，较高的氧水平（50%和100%氧合）能更好地支持有氧机制。
