Human Transplant Kidneys on Normothermic Machine Perfusion Display Endocrine Activity

Hui Lin; Zhaoyu Du; Sarah Bouari; Elsaline Rijkse; Iacopo Cristoferi; Anja Obser; Jan Czogalla; A H Jan Danser; Robert C Minnee; Martin J Hoogduijn

doi:10.1097/TXD.0000000000001503

Human Transplant Kidneys on Normothermic Machine Perfusion Display Endocrine Activity

Transplant Direct. 2023 Jun 9;9(7):e1503. doi: 10.1097/TXD.0000000000001503. eCollection 2023 Jul.

Authors

Affiliations

¹ Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, University Medical Center, Rotterdam, The Netherlands.
² Department of Internal Medicine, Erasmus MC Transplant Institute, University Medical Center Rotterdam, The Netherlands.
³ Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC Transplant Institute, University Medical Center Rotterdam, The Netherlands.
⁴ III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Abstract

Normothermic machine perfusion (NMP) is an alternative to hypothermic machine perfusion (HMP) for donor kidney preservation before transplantation. Contrary to HMP, NMP allows for functional assessment of donor kidneys because normothermic conditions allow for metabolic activity. The kidneys are key producers of hormones. Yet, it remains unknown whether donor kidneys during NMP display endocrine functions.

Methods: Fifteen donor kidneys were subjected to HMP followed by 2 h of NMP before transplantation. NMP perfusate was collected at 3 time points (0, 1, 2 h) for the measurements of prorenin/renin, erythropoietin (EPO), and vitamin D, and urine samples were collected at 1 h and 2 h for urodilatin measurement. Fifteen HMP perfusate samples were collected for the same measurements.

Results: Kidneys on NMP secreted significantly more prorenin, renin, EPO, and active vitamin D than during HMP. EPO and vitamin D secretion remained stable during 2 h of NMP, whereas the prorenin release rate increased and renin release rate decreased after 1 h. Donation after brain death kidneys secreted more vitamin D and less EPO during NMP than donation after circulatory death kidneys. Twelve donor kidneys produced urine during NMP and released detectable levels of urodilatin. Kidneys exhibited a large variation in hormone release rates. No significant differences were found in hormone release capacity between delayed graft function (DGF) and non-DGF kidneys, and no significant correlations were found between hormone release rates and the duration of DGF or 1-mo posttransplant serum creatinine levels.

Conclusions: Human transplant kidneys display endocrine activity during NMP. To explore whether correlations exist between hormone release rates and posttransplant kidney function, large numbers of kidneys are required.