Signs of a Dying Organ: Beyond Resistance in Subnormothermic Kidney Perfusion.
Cleveland Clinic, Cleveland, OH.
Meeting: 2016 American Transplant Congress
Abstract number: C128
Keywords: Kidney, Machine preservation, Pig, Preservation
Session Information
Date: Monday, June 13, 2016
Session Name: Poster Session C: Ischemia Reperfusion Injury and Organ Preservation
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
Purpose: In hypothermic machine preservation of the kidney, resistance is often used to assess organ quality. Since no prognostic standard yet exists for subnormothermic ex-vivo organ perfusion (EVOP), the purpose of this study is to explore prognostic factors by determining what other functional markers are associated with resistance.
Methods: Fourteen DCD porcine kidneys were perfused in a subnormothermic (21-24[deg]C) EVOP model with Steen solution (n=10) or Krebs-Henseleit Buffer with albumin (n=4). Univariate linear regression was performed with 16-hour resistance as the primary outcome. Variables recorded at 16 hours were modeled, including mean arterial pressure, oxygen consumption, arterial-venous oxygen pressure difference, sodium, potassium, calcium, glucose, and lactate levels, and both arterial and venous H+ concentration, bicarbonate, PO2, PCO2, and base excess (BE). Statistically significant variables (P < 0.05) were analyzed for outliers, and multivariate linear regression was performed.
Results: Univariate analysis identified 5 variables as significant: PaO2, PaCO2, venous BE, venous bicarbonate, and arterial H+. When the most extreme outlier was removed from each variable analysis, only the directional relationships of venous BE and venous bicarbonate were unchanged. In multivariate linear regression featuring venous BE and venous bicarbonate, neither was significant. There was a significant positive correlation between these two variables (r = 0.9477, P < 0.001).
| Univariate Linear Regression | |
| PaO2 | β = -0.0011, P = 0.0158, R2 = 0.46 |
| PaCO2 | β = 0.0130, P = 0.0017, R2 = 0.64 |
| Venous BE | β = 0.0076, P = 0.0214, R2 = 0.46 |
| Venous bicarbonate | β = 0.0104, P = 0.0401, R2 = 0.39 |
| Arterial H+ | β = 5.593 x 106, P = 0.0338, R2 = 0.38 |
| Multivariate Linear Regression | |
| Venous BE | β = 0.0097, P = 0.3157 |
| Venous bicarbonate | β = -0.0033, P = 0.8138 |
| R2=0.47 | |
Conclusion: At 16 hours of subnormothermic kidney perfusion, venous base excess and venous bicarbonate are directly associated with increased renal artery resistance, suggesting a role for alkalosis in microcirculatory stability. Increased resistance is directly associated with PaCO2 and arterial H+ and inversely associated with PaO2. However, since these associations were severely altered when outlier values were removed from analysis, we can conclude that this relationship is most apparent at extreme values.
CITATION INFORMATION: Blum M, Urcuyo D, Liu Q, Soliman B, Okamoto T, Goldfarb D, Quintini C. Signs of a Dying Organ: Beyond Resistance in Subnormothermic Kidney Perfusion. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Blum M, Urcuyo D, Liu Q, Soliman B, Okamoto T, Goldfarb D, Quintini C. Signs of a Dying Organ: Beyond Resistance in Subnormothermic Kidney Perfusion. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/signs-of-a-dying-organ-beyond-resistance-in-subnormothermic-kidney-perfusion/. Accessed March 3, 2021.« Back to 2016 American Transplant Congress