Normothermic Ex-Vivo Kidney Perfusion Preservation Consistently Improves Extreme Marginal Graft Function Compared to Hypothermic Machine Perfusion

P. Urbanellis¹, M. Hamar¹, I. Linares¹, D. Kollmann¹, S. Ganesh¹, F. Oquendo¹, M. Sharma¹, R. John¹, A. Ghanekar¹, I. Mucsi¹, D. Bagli², A. Konvalinka¹, L. Robinson³, M. Selzner¹

¹Multi-Organ Transplantation Program, University Health Network, Toronto, ON, Canada, ²Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada, ³Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada

Meeting: 2019 American Transplant Congress

Abstract number: 600

Keywords: Kidney transplantation, Preservation, Renal function, Renal injury

Session Information

Session Name: Concurrent Session: Ischemia Reperfusion & Organ Rehabilition III

Session Type: Concurrent Session

Date: Tuesday, June 4, 2019

Session Time: 4:30pm-6:00pm

Presentation Time: 4:42pm-4:54pm

Location: Room 313

*Purpose: Normothermic ex-vivo kidney perfusion (NEVKP) is an emerging technique for renal graft preservation. We investigated whether NEVKP promoted improved marginal graft function compared to anoxic hypothermic machine perfusion (HMP) in a model of donation-after-cardiac-death (DCD).

*Methods: Kidneys from 30kg-Yorkshire pigs were removed following 120min of warm ischemia (WI). These grafts were preserved with HMP (LifePort 1.0, n=7) or NEVKP (n=7) for 8-hrs prior to heterotopic autotransplantation.

*Results: During NEVKP, 120min WI grafts cleared perfusion lactate (0hr:10.48±0.93mmol/L vs 7hr:1.48±0.85mmol/L,p<0.01), had decreasing intra-renal resistance (IRR) (0hr:2.26±0.9mmHg/mL/min vs 7hr:0.37±0.6mmHg/mL/min,p<0.01), and consistently produced urine. IRR also decreased in HMP (0hr:1.71±0.30mmHg/mL/min vs 7hr:1.19±0.37mmHg/mL/min, p=0.01). Post-transplantation, 120min WI grafts with NEVKP trended towards earlier and decreased serum creatinine peak values compared to HMP (POD3:12.29±2.16mg/dL vs POD5:16.62±6.74mg/dL,p=0.13). From POD5-7, the HMP group demonstrated a bimodal distribution in serum creatinine leading to increased variance compared to NEVKP (standard deviation = 6.74, 9.28, 9.38mg/mL vs 5.72, 6.25, 4.75mg/mL, respectively). In the HMP group, 4 of the 7 grafts were poor performing with two of these developing renal vein thrombosis. Conversely, only 1 of the 7 grafts was poor performing in the NEVKP group and there was no evidence of renal vein thrombosis (Figure 1). The consistent improvement in NEVKP vs heterogeneity in HMP was also observed through the variation in creatinine clearance (POD7: 26.31±11.54mL/min vs 16.8±18.9mL/min) and on histological analysis of tubular injury.

*Conclusions: Marginal kidney grafts subjected to 120min of WI before retrieval showed reliable improvement in function following 8hrs of continuous NEVKP compared to HMP where improvement was inconsistent. This suggests NEVKP would be a preferable storage strategy for DCD procured grafts with extended WI times.

To cite this abstract in AMA style:

Urbanellis P, Hamar M, Linares I, Kollmann D, Ganesh S, Oquendo F, Sharma M, John R, Ghanekar A, Mucsi I, Bagli D, Konvalinka A, Robinson L, Selzner M. Normothermic Ex-Vivo Kidney Perfusion Preservation Consistently Improves Extreme Marginal Graft Function Compared to Hypothermic Machine Perfusion [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/normothermic-ex-vivo-kidney-perfusion-preservation-consistently-improves-extreme-marginal-graft-function-compared-to-hypothermic-machine-perfusion/. Accessed May 18, 2025.

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