EVNP has been used to assess and repair marginal organs prior to transplantation but the optimal perfusate composition is unknown. We hypothesize that EVNP with a plasma enriched perfusate may improve metabolism and function of kidneys compared to a crystalloid based perfusate.

Eight paired sheep kidneys were assessed on EVNP at 37^oC perfused with oxygenated packed red blood cells, parenteral nutrition mixed with a 1:1 dilution of either platelet poor plasma or Plasmalyte-A (Crystalloid). After a 3-hour assessment period on EVNP, both groups were perfused with whole blood (WB) for 3 hours to simulate early clinical allograft reperfusion. Hemodynamic parameters, urine output and perfusate samples were serially collected for pH, oxygen, electrolytes, creatinine, and lactate levels. Renal biopsies were collected for histology.

During the assessment period kidneys perfused with both solutions showed similar gradual improvement in flow and resistance, and a decrease in perfusate lactic acid and creatinine levels over time. The plasma group had higher perfusate sodium levels and gained less weight but made less urine during the assessment period when compared to crystalloid. During the WB reperfusion period, both groups had similar hemodynamic parameters and perfusate creatinine levels decreased in both groups, but the plasma perfused kidneys had more urine output and lower perfusate lactic acid levels compared to crystalloid kidneys.

EVNP with plasma enriched perfusate resulted in less renal edema, improved metabolism and more urine production in an ex vivo simulated transplant model. Further studies are needed to investigate potential protective mechanisms of plasma perfusion and whether EVNP with plasma will improve outcomes in a whole animal transplant model.

CITATION INFORMATION: Palma J., Palma I., Smolin Y., Perry A., Sageshima J., Perez R. The Superiority of Plasma Enriched Perfusate for Assessment of Donor Kidneys in an Ex-Vivo Normothermic Perfusion (EVNP) Setting Am J Transplant. 2017;17 (suppl 3).

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