Urine Recirculation Maintains Hemodynamics and Enhances Function in Normothermic Kidney Perfusion
1Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria, 2Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom, 3OrganOx Limited, Oxford, United Kingdom, 4Oxford Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
Meeting: 2019 American Transplant Congress
Abstract number: D251
Keywords: Kidney, Machine preservation, Perfusion solutions, Pig
Session Information
Session Name: Poster Session D: Non-Organ Specific:Organ Preservation/Ischemia Reperfusion Injury
Session Type: Poster Session
Date: Tuesday, June 4, 2019
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: The purpose was to compare urine recirculation (URC) and urine replacement with Ringer’s lactate in a porcine normothermic kidney perfusion (NKP) model using a transportable normothermic perfusion device.
*Methods: Pigs (n=10) were allocated to either NKP with URC (n=5) or NKP without URC (n=5), where Ringer’s lactate replaced urine output ml per ml. Animals were anaesthetised and both kidneys were retrieved, uninjured. One kidney was placed on NKP after 2h cold ischemia time (CIT) and the remaining kidney was static cold stored for 27h and then placed on NKP. An autologous blood-based perfusate solution, leukocyte-filtered, was used and NKP was performed up to 24h. Perfusion parameters, biochemistry and metabolic parameters were monitored and perfusate, urine and tissue samples were collected for analysis.
*Results: Physiological mean arterial pressures and flows were achieved in perfusions with and without URC, within the first hour of perfusion but remained stable throughout the whole perfusion period only with URC. Significantly higher arterial flow levels could be achieved with URC; arterial flow of 318.1±97ml/min with URC vs 220.5±118.3ml/min in NKP with urine replacement, p<0.0001. The duration of CIT before NKP start had no impact on arterial flow. Perfusate sodium levels were higher without URC, 129.9±12.3 with URC vs 158.7±19.4 without; p<0.001. pH was stable at physiological levels only in NKP with URC. Lactate levels, compared within each kidney pair, were lower with URC 2.55±1.28 vs 6.9±1.6 without URC; p<0.001. The hourly urine output was higher in NKP without URC; 548±450.8ml/h vs 150±21.3ml/h with URC, p=0.008. The achieved duration of NKP (up to 24h) was significantly longer in NKP with URC, 17.3±9.2 vs 5.3±1.3 NKP without; p=0.02. The main reason to terminate NKP was arterial flow ≤50ml/min. The tubular condition before NKP start was slightly inferior in the zero biopsies with the longer CIT. The baseline tubular condition appeared unchanged after NKP with and without URC.
*Conclusions: Normothermic kidney perfusion using a portable prototype device preserves the parenchymal quality of healthy porcine kidneys with and without URC. Urine recirculation is needed to maintain hemodynamics, perfusate volume and homeostasis and to readily achieve long-term NKP up to 24 hours.
To cite this abstract in AMA style:
Weissenbacher A, Ceresa CD, Voyce D, Hunter J, Ploeg R, Coussios CC, Friend P. Urine Recirculation Maintains Hemodynamics and Enhances Function in Normothermic Kidney Perfusion [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/urine-recirculation-maintains-hemodynamics-and-enhances-function-in-normothermic-kidney-perfusion/. Accessed May 11, 2025.« Back to 2019 American Transplant Congress