Effectiveness of a machine perfusion preservation system, developed by industry-academic collaboration for warm ischemic porcine kidney

Abstract

【Objective】 Expanded criteria donors (ECD), or marginal donors including donation after cardiac death (DCD), are now accepted as a one of the most important solutions for the shortage of organ donors in the world. A greater risk of severe ischemic reperfusion injury may lead delayed graft function (DGF), primary non-function (PNF), and poor graft survival. The aim of this study is to access the possibility of experimental kidney transplantation with warm chemically-injured kidney graft preserved with a machine perfusion system.

【Methods】 Domestic pigs weighing 30 kg were used in this study. A 30-minute warm ischemic time (WIT) was induced by clamping the renal artery. Group 1; Kidney was preserved with simple cold storage (CS) in UW solution for 22 hrs. Group 2; Kidney was preserved with CS for 5 hrs and perfused with a hypothermic machine perfusion preservation (HMP) system. Kidney was reperfused by ex vivo autologous blood transfusion and evaluated for 30 minutes. The hemodynamic parameters and urine volume were measured. In addition, histological and immunohistochemical findings were investigated.

【Results】 The serum creatinine level was remarkably lower in the HMP group than in the CS group. An initial urine volume was found in the HMP group, but not in the CS group. Histological findings revealed severe degeneration in tubular cells in the CS group compared to the HMP group. Additionally, immunohistological findings demonstrated endothelial cells were significantly exfoliated to a more severe extent and platelet aggregation occurred more frequently in the CS group than in the HMP group.

【Conclusion】 Using machine perfusion is the preferred preservation approach for warm ischemic kidney with long cold preservation time.