Normothermic Machine Perfusion of Human Kidneys without an Oxygen Carrier
Massachusetts General Hospital, Boston, MA
Meeting: 2019 American Transplant Congress
Abstract number: B15
Keywords: Donors, marginal, Kidney, Machine preservation
Session Information
Session Name: Poster Session B: Ischemia Reperfusion & Organ Rehabilition
Session Type: Poster Session
Date: Sunday, June 2, 2019
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: Normothermic machine perfusion (NMP) is a promising strategy for pre-transplant reconditioning and viability assessment of marginal renal grafts. All current clinical kidney NMP protocols utilize packed red blood cells (pRBC) as an oxygen carrier in the perfusate. This introduces logistical hurdles and potential immunologic risk for the recipient. This feasibility study evaluates whether an oxygenated, cell-free perfusate is sufficient to sustain the ex-vivo function and viability of human kidney grafts, compared to a pRBC-based perfusate.
*Methods: 12 human kidneys, declined for transplantation, were perfused for 6 hours at 37°C. Kidneys were perfused with a pRBC-based perfusate (RBC-group, n=3), or a Williams E-based perfusate (WE-group, n=9). The perfusate was oxygenated with a gas mixture of 95% O2/5% CO2.
*Results: The WE-group vascular resistance declined steadily throughout perfusion whereas the RBC-group demonstrated an initial spike in resistance, then declined. The resistance was not significantly different over the course of perfusion (Table 1).
WE | Blood | p-value | |
Renal Blood Flow (mL/min/100g) | 150 +/- 17.69 |
100.2 +/- 8.37
|
0.2091
|
Vascular Resistance (mmHg*mL*min-1) |
0.15 +/- 0.01
|
0.16 +/- 0.02
|
0.7000
|
Creatinine Decrease (% of baseline) |
59.74 +/- 8.44
|
80.64 +/- 14.71
|
0.3048
|
Total UOP (mL) |
204.1 +/- 86.03
|
19.92 +/- 17.4
|
0.2773
|
Renal artery flow was higher in the WE-group throughout perfusion (p=0.0002). O2 delivery was higher in the RBC-group (p=<0.0001) and the O2 extraction ratio was higher in WE-group (p=0.0014), however, O2 consumption was similar between groups (p=0.1661), indicating that sufficient dissolved O2 is present in the perfusate to support aerobic metabolism (Figure 1).
ATP content (p=0.1304) and energy charge (p=0.8785) were similar between groups, indicating a similar overall energy state during perfusion (Figure 2).
*Conclusions: Oxygenated NMP without a heme-based oxygen carrier is feasible for up to 6 hours, resulting in stable hemodynamics, adequate oxygen delivery to support aerobic metabolism, and similar ATP restoration compared to standard pRBC-based protocols.
To cite this abstract in AMA style:
Detelich D, Eymard C, Aburawi M, Carroll C, Uygun K, Yeh H, Markmann JF. Normothermic Machine Perfusion of Human Kidneys without an Oxygen Carrier [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/normothermic-machine-perfusion-of-human-kidneys-without-an-oxygen-carrier/. Accessed December 10, 2024.« Back to 2019 American Transplant Congress