Early experience of 48-hour normothermic machine perfusion in human kidneys applying urine recirculation
Franka Messner1, Silvia Gasteiger1, Marlene Pühringer1, Afshin Soleiman2, Dietmar Öfner1, Stefan Schneeberger1, Annemarie Weissenbacher1.
1Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria; 2INNPATH, Institute of Pathology, Tirol Kliniken Innsbruck, Innsbruck, Austria
Introduction: Normothermic machine perfusion (NMP) of the kidney has been studied extensively during the past decade. Short-term kidney NMPhas demonstrated promising results, however currently transplant logistics cannot be improved and for organ treatment longer preservationperiods might be necessary. As a proof of principle, we aimed to achieve 48-hour NMP by applying urine recirculation (UR) with a commerciallyavailable perfusion device.
Methods: Discarded human kidneys were normothermically perfused on the XVIVO Kidney Assist perfusion device. The perfusate comprisedpacked red cells and 5% albumin. For volume management UR was applied. Air (21% O2) and CO2 were used for oxygenation of the circuit andmonitored with an in-line blood gas analyzer. Perfusate and urine samples as well as hemodynamics were regularly assessed.
Results: Five discarded human kidneys underwent kidney NMP following hypothermic machine perfusion (HMP) and static cold storage. All butone kidneys were DBD organs. Median donor age (range) was 62 (41-68) years. Median (IQR) CIT and HMP were 19.9 (12.1) h and 5 (7.2) h. AnNMP duration of 48 h could be achieved in all kidneys. All kidneys were urinating throughout with a median (IQR) output of 22.5 (30.5) ml/h.Overall median (IQR) arterial flow was 695 (383) ml/min. Median (IQR) pH was 7.2 (0.2). Overall median (IQR) perfusate sodium, chloride andpotassium were 161 (14.7) mmol/L, 124.5 (11.5) mmol/L, and 6.5 (2.7) mmol/L. Median (IQR) perfusate lactate over time was 109 (55.2) mg/dL.Median perfusate sodium and chloride were significantly higher than corresponding urine values (sodium: 130 (27) mmol/L, chloride: 120.5(11.8) mmol/L) over time (P = 0.02 and 0.04). Median arterial flow over time was significantly higher in NMP kidneys with lower perfusate sodiumlevels (p<0.001, correlations coefficient Spearman’s rho -0.461).
Conclusions: This early experience underlines the feasibility of extended ex-situ kidney NMP by applying UR. Hemodynamic stability and urineexcretion were achieved for 48 hours.
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