Introduction:

Machine perfusion for preservation of donated organs led to compelling success for the outcome of renal transplantation. Though, further refinements of methods to decrease ischemia reperfusion injury remain an issue of high interest in this field. The present study investigates functional aspects of subnormothermic (20°C) machine perfusion for kidney preservation in non-heart-beating-donors.

Methods:

Kidneys were retrieved from landrace pigs (approx. 30 kg body weight). After a period of warm ischemia of 30 minutes kidneys were randomly assigned to preservation for 7 hours by oxygenated subnormothermic (20°C) machine perfusion (SNTMP), hypothermic (4°C) machine perfusion (HMP) or static cold storage (CS)(n=5, resp.). Afterwards kidneys were reperfused for 2 hours with autologous blood in an in vitro model for assessment of function and integrity.

Results:

Kidney preservation by SNMTP led to significantly higher renal blood flow and significantly better renal clearance of creatinine during the in vitro reperfusion compared to HMP and CS. Fractional excretion of sodium showed significantly lower values compared to HMP and CS, indicating less tubular injury. Amount of diuresis was 2-3 fold and 3-5 fold increased after preservation by SNTMP when compared to HMP and CS, respectively. Comparison of HMP to CS preservation revealed significantly better renal creatinine clearance and lower values of fractional excretion of sodium in favor of HMP during the in vitro reperfusion. Release of gGT into urine was highest after HMP when compared to SNTMP and CS. Release of lactate dehydrogenase into serum was similar in all groups.

Conclusion:

Subnormothermic machine perfusion seems to be an advantageous method to preserve kidneys retrieved from non-heart-beating-donors for a medium time period.

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