Studies have shown that Ex-Vivo Normothermic Perfusion (EVNP) has the potential to assess viability and function of high-risk deceased donor kidneys. A diuretic response to furosemide has been used clinically to determine which patients will recover from acute kidney injury (AKI). Our aim is to use the FST with EVNP to determine which kidneys can recover from AKI and potentially be transplanted.

Paired human kidneys from 5 deceased donors with AKI initially procured for transplantation but discarded were placed on 3 hours of EVNP pressure dependent cardiopulmonary bypass system at 37[deg] C. Perfusate contained leukocyte depleted packed red blood cells (PRBC) with or without a one-time dose of Furosemide (10 mg), FST+ and FST-, respectively. All kidneys were supplemented with parenteral nutrition and insulin. Exogenous creatinine (0.06 g) was added to the system to assess glomerular filtration. Pump parameters were monitored every 15 min. Blood samples and urine samples were collected every 30 min and analyzed for pH, oxygen, electrolytes, creatinine, and lactate.

Mean donor age was 55 + 12.17 years, kidney donor profile index (KDPI) was 80.2 + 17.2, terminal creatinine was 3.06 + 1.39 mg/dL, and cold ischemia time was 45.52 + 11.9. Response to FST was defined as moderate (urine difference > 15cc/hr ), low (urine difference < 15cc/hr) or no response. 2 kidneys showed a moderate response to FST in total urine output after 3 hours of EVNP, 2 showed a low response to FST, and 1 had no response to FST. Kidneys that had a moderate response to FST had higher blood flow and lower resistance over time and had lower creatinine and lactate perfusate levels. Injured kidneys on EVNP may demonstrate both a hemodynamic and diuretic response to FST. The potential usefulness of the FST in evaluating high risk kidneys on EVNP needs further investigation.

CITATION INFORMATION: Palma I, Smolin Y, Kabagambe S, Perry A, Palma I, Sageshima J, Perez R. The Use of a Furosemide Stress Test (FST) for Assessment of Discarded Deceased Donor Kidneys in an Ex-Vivo Normothermic Perfusion Model. Am J Transplant. 2017;17 (suppl 3).

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