Date: Sunday, April 30, 2017
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall D1
Background: Normothermic ex-vivo kidney perfusion (NEVKP) is an emerging technique for renal graft preservation. We investigated whether NEVKP could promote improved marginal graft function compared to cold storage in a model of donation after cardiac death.
Methods: Kidneys from 30kg Yorkshire pigs were removed following 30, 60, 90, or 120 minutes of warm ischemia (WI). These grafts were then preserved in either cold histidine-tryptophan-ketoglutarate solution or subjected to pressure-controlled NEVKP for 8 hours prior to heterotopic autotransplantation.
Results: Prolonging WI time prior to kidney retrieval and subsequent storage in cold solution resulted in grafts that demonstrated incremental posttransplant increases in serum creatinine with grafts subjected to 120min of WI having persistent elevation (POD7: 13.45±3.50mg/dl vs baseline: 1.1±0.33mg/dl p<0.01, n=4). During NEVKP perfusion, 120min WI grafts cleared lactate from perfusion solution (0hr: 10.48±0.93mmol/L vs 7hr: 1.48±0.85mmol/L, p<0.01), had decreasing intra-renal resistance (0hr: 2.26±0.9mmHg/mL/min vs 7hr: 0.37±0.6mmHg/mL/min, p<0.01), and consistent urine production. Posttransplantation, 120min WI grafts with NEVKP, compared to cold storage, demonstrated significantly decreased serum creatinine peak values (POD4: 12.62±2.34mg/dl vs POD5: 18.95±1.11mg/dL, p=0.001) and higher creatinine clearance (POD4: 6.61±4.03mL/min vs 0.35±0.30mL/min, p=0.02 and POD7: 26.31±11.54mL/min vs 9.78±4.6mL/min, p=0.03). On POD7, serum creatinine also returned to baseline values in the NEVKP group (POD7: 4.88±5.57mg/dL vs baseline: 1.02±0.16mg/dL, p=0.16).
Conclusion: Kidney grafts subjected to 120min of warm ischemia before retrieval showed significant improvement in function following 8hrs of continuous pressure controlled NEVKP compared to cold storage. This suggests NEVKP could be utilized to expand the donor pool through the consideration of extreme marginal grafts for transplantation.
CITATION INFORMATION: Urbanellis P, Hamar M, Linares I, Kollmann D, Cassol C, John R, Yip P, Mucsi I, Ghanekar A, Bagli D, Grant D, Robinson L, Selzner M. Normothermic Ex-Vivo Kidney Perfusion Improves Function of Extreme Marginal Renal Grafts Subjected to Prolonged Ischemia. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:Urbanellis P, Hamar M, Linares I, Kollmann D, Cassol C, John R, Yip P, Mucsi I, Ghanekar A, Bagli D, Grant D, Robinson L, Selzner M. Normothermic Ex-Vivo Kidney Perfusion Improves Function of Extreme Marginal Renal Grafts Subjected to Prolonged Ischemia. [abstract]. Am J Transplant. 2017; 17 (suppl 3). http://atcmeetingabstracts.com/abstract/normothermic-ex-vivo-kidney-perfusion-improves-function-of-extreme-marginal-renal-grafts-subjected-to-prolonged-ischemia/. Accessed January 16, 2018.
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