Combining Oxygenated Cold Perfusion with Normothermic Ex-vivo Perfusion Improves the Outcome of DCD Porcine Kidney Transplantation

L. I. Mazilescu¹, T. Goto¹, R. Rosales¹, Y. Noguchi¹, P. Urbanellis¹, L. A. Robinson², M. Selzner¹

¹Ajmera Transplant Program, Toronto General Hospital, Toronto, ON, Canada, ²Department of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada

Meeting: 2021 American Transplant Congress

Abstract number: 607

Keywords: Preservation, Renal injury

Topic: Basic Science » Ischemia Reperfusion & Organ Rehabilitation

Session Information

Session Name: Ischemia Reperfusion & Organ Rehabilitation

Session Type: Poster Abstract

Session Date & Time: None. Available on demand.

Location: Virtual

*Purpose: Ex-vivo machine perfusion is a novel preservation technique for the storage and assessment of marginal kidney grafts. Normothermic (NEVKP) as well as hypothermic machine perfusion (HMP) with and without oxygen have been developed in the recent past. All ex-vivo perfusion techniques have advantages and shortcomings. NEVKP reduces cold ischemic injury with opportunities for graft assessment. In contrast, HMP is easier to perform during transportation, but graft assessment is limited. In the current study, we assessed if a combination of oxygenated HMP (oxHMP) followed by a short NEVKP period could combine the advantages of both preservation techniques.

*Methods: All pig kidneys were exposed to 30min of warm ischemia followed by ex-vivo perfusion. Three ex-vivo perfusion techniques were compared. Kidneys either underwent 16hr NEVKP or were preserved by 16hr oxHMP. The third group was treated with 16hr oxHMP followed by 3hr NEVKP (oxHMP+NEVKP group). After contralateral nephrectomy, grafts were autotransplanted and animals were followed for 8 days. Kidney function and injury markers were compared between groups.

*Results: All animals survived the follow-up period. Grafts preserved by continuous NEVKP showed improved function with lower peak serum creatinine (SrCrea) and more rapid recovery compared to the other two groups (peak SrCrea NEVKP vs oxHMP vs oxHMP+NEVKP: 3.7±1.3mg/dl vs 9±5.5mg/dl vs 3.9±1.4mg/dl). The differences in daily SrCrea levels reached significance between NEVKP and oxHMP on POD 7 and 8 (both p<0.05) and between NEVKP and oxHMP+NEVKP on POD1 (p=0.04). Similarly, there was a significant difference in daily SrCrea between oxHMP+NEVKP and oxHMP on POD1, 2 and 7 (all p<0.05). On POD3, creatinine clearance was increased in the NEVKP and oxHMP+NEVKP group (NEVKP vs oxHMP vs oxHMP+NEVKP: 41±19mL/min vs 13±13mL/min vs 29.4±11.5mL/min, p=0.034). Urine neutrophil gelatinase-associated lipocalin, as a marker of kidney injury, was significantly lower on POD 3 in the oxHMP+NEVKP group compared the other two groups (p=0.0021).

*Conclusions: A short period of NEVKP following oxHMP provides the same outcomes as prolonged NEVKP in DCD kidney transplantation and is superior to oxHMP alone. A combination of oxHMP with end-ischemic NEVKP could be an attractive practical strategy to combine the advantages of both preservation techniques.

To cite this abstract in AMA style:

Mazilescu LI, Goto T, Rosales R, Noguchi Y, Urbanellis P, Robinson LA, Selzner M. Combining Oxygenated Cold Perfusion with Normothermic Ex-vivo Perfusion Improves the Outcome of DCD Porcine Kidney Transplantation [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/combining-oxygenated-cold-perfusion-with-normothermic-ex-vivo-perfusion-improves-the-outcome-of-dcd-porcine-kidney-transplantation/. Accessed May 16, 2025.

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