Ex Vivo Bloodless Oxygen Carrier for Perfusion of DCD Kidneys during Subnormothermic Storage

P. Luke,^1,2 M. Richard-Mohamed,² A. Haig,³ R. Mayer,² S. Aquil,² A. Sener,² A. Jevnikar,^1,2 R. Bhattacharjee.^1,2

¹Matthew Mailing Centre for Translational Transplant Studies, London, ON, Canada
²Multi-Organ Transplant Program, London Health Sciences Centre, London, ON, Canada
³Pathology and Laboratory Medicine, London Health Sciences Centre, London, ON, Canada.

Meeting: 2018 American Transplant Congress

Abstract number: D23

Keywords: Donors, Kidney transplantation, Machine preservation, marginal, Preservation solutions

Session Information

Session Name: Poster Session D: Immunosuppression Preclinical Studies

Session Type: Poster Session

Date: Tuesday, June 5, 2018

Session Time: 6:00pm-7:00pm

Presentation Time: 6:00pm-7:00pm

Location: Hall 4EF

Background: Non-oxygenated static or machine perfusion in cold (4^[deg]C) remains the gold standard in transplantation and an optimal method of oxygen delivery to ischemic kidneys during ex vivo storage has not been established yet. By using porcine model DCD kidneys, we concluded that subnormothermic (22[deg]C) oxygenated blood perfusion is superior to both static cold and normothermic preservation. Therefore, we aimed to study an acellular hemoglobin-based oxygen carrier (HBOC) in order to protect DCD kidneys during storage from storage injury, clotting and lysis.

Methods: To simulate DCD condition, kidneys were retrieved after 30 min warm ischemia by cross-clamping the renal pedicle in situ. Organs were flushed with cold HTK and subjected to pulsatile blood perfusion at 22^[deg]C for 4h with a) HBOC: Plasmalyte solution b) blood: Plasmalyte solution. All kidneys were then reperfused with normothermic (37^[deg]C) oxygenated blood for 4h. Total urine output, urinary protein, albumin/creatinine ratio, and flow rate were measured. Acute tubular necrosis (ATN) and apoptosis (TUNEL) were scored by H&E and TUNEL staining.Martius Scarlet Blue (MSB) staining confirmed intra-renal hemorrhage.

Results: Compared to the blood, HBOC perfusion significantly reduced ATN and apoptosis in histology sections (score 10±5% vs. 60±10%). Consistently, reduced expression of urinary kidney damage markers (KIM1 & NGAL) decreased urinary protein and lower protein/creatinine ratio (50±10 vs. 90±18 mg/mmol) were associated with HBOC perfusion. Moreover, increased renal blood flow rate (100mL/min vs. 50mL/min) and higher urine output (750±60mL vs. 250±80mL) were observed in HBOC groups. HBOC-perfused kidneys manifested no intra-renal hemorrhage and blood clot during 4h of reperfusion.

Conclusion: HBOC perfusion at 22^[deg]C showed significant advantages compared to both static cold storage as well as blood perfusion. It improves flow rate and urine output ex vivo, reduces cell death during preservation and offers promise as a new and innovative technique for organ preservation.

CITATION INFORMATION: Luke P., Richard-Mohamed M., Haig A., Mayer R., Aquil S., Sener A., Jevnikar A., Bhattacharjee R. Ex Vivo Bloodless Oxygen Carrier for Perfusion of DCD Kidneys during Subnormothermic Storage Am J Transplant. 2017;17 (suppl 3).

To cite this abstract in AMA style:

Luke P, Richard-Mohamed M, Haig A, Mayer R, Aquil S, Sener A, Jevnikar A, Bhattacharjee R. Ex Vivo Bloodless Oxygen Carrier for Perfusion of DCD Kidneys during Subnormothermic Storage [abstract]. https://atcmeetingabstracts.com/abstract/ex-vivo-bloodless-oxygen-carrier-for-perfusion-of-dcd-kidneys-during-subnormothermic-storage/. Accessed May 16, 2025.

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