Prolonged ex-vivo normothermic kidney perfusion: The impact of perfusate composition

PLoS One. 2021 May 18;16(5):e0251595. doi: 10.1371/journal.pone.0251595. eCollection 2021.

Abstract

Normothermic machine perfusion (NMP) of donor kidneys provides the opportunity for improved graft preservation and objective pre-transplant ex-vivo organ assessment. Currently, a multitude of perfusion solutions exist for renal NMP. This study aimed to evaluate four different perfusion solutions side-by-side and determine the influence of different perfusate compositions on measured renal perfusion parameters. Porcine kidneys and blood were obtained from a slaughterhouse. Kidneys underwent NMP at 37°C for 7 hours, with 4 different perfusion solutions (n = 5 per group). Group 1 consisted of red blood cells (RBCs) and a perfusion solution based on Williams' Medium E. Group 2 consisted of RBCs, albumin and a balanced electrolyte composition. Group 3 contained RBCs and a medium based on a British clinical NMP solution. Group 4 contained RBCs and a medium used in 24-hour perfusion experiments. NMP flow patterns for solutions 1 and 2 were similar, solutions 3 and 4 showed lower but more stable flow rates. Thiobarbituric acid reactive substances were significantly higher in solution 1 and 4 compared to the other groups. Levels of injury marker N-acetyl-β-D glucosaminidase were significantly lower in solution 2 in comparison with solution 3 and 4. This study illustrates that the perfusate composition during NMP significantly impacts the measured perfusion and injury parameters and thus affects the interpretation of potential viability markers. Further research is required to investigate the individual influences of principal perfusate components to determine the most optimal conditions during NMP and eventually develop universal organ assessment criteria.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Kidney / physiopathology*
  • Kidney Transplantation*
  • Organ Preservation*
  • Perfusion*
  • Swine

Grants and funding

This research was funded by the Dutch Kidney Foundation, grant number 14OKG01 (awarded to CM). URL: https://www.nierstichting.nl/ The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.