Leonie H Venema1, Aukje Brat1, Cyril Moers1, Nils A 't Hart2, Rutger J Ploeg3, Patrick Hannaert4, Thomas Minor5, And Henri G D Leuvenink1. 1. Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands. 2. Department of Pathology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands. 3. Department of Surgery, Nuffield Department of Surgical Science, University of Oxford, Oxford, United Kingdom. 4. IRTOMIT, INSERM U1082, Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France. 5. Department for Surgical Research/General Surgery, University Hospital Essen, Essen, Germany.
Abstract
BACKGROUND: Hypothermic machine perfusion (HMP) has become standard care in many center's to preserve kidneys donated after circulatory death (DCD). Despite a significant reduction in metabolism at low temperatures, the remaining cellular activity requires oxygen. Because of the role and safety of oxygen during HMP has not been fully clarified, its supply during HMP is not standard yet. This study investigates the effect of administering oxygen during HMP on renal function in a porcine DCD model. METHODS: After 30 minutes of warm ischemia, porcine slaughterhouse kidneys were preserved for 24 hours by means of cold storage (CS), or HMP with Belzer Machine Perfusion Solution supplemented with no oxygen, 21% or 100% oxygen. Next, kidneys were reperfused for 4 hours in a normothermic machine perfusion setup. RESULTS: HMP resulted in significantly better kidney function during normothermic machine perfusion. Thiobarbituric acid-reactive substances, markers of oxidative stress, were significantly lower in HMP preserved kidneys. HMP preserved kidneys showed significantly lower aspartate aminotransferase and lactate dehydrogenase levels compared with kidneys preserved by CS. No differences were found between the HMP groups subjected to different oxygen concentrations. Adenosine triphosphate levels significantly improved during HMP when active oxygenation was applied. CONCLUSIONS: This study showed that preservation of DCD kidneys with HMP is superior to CS. Although the addition of oxygen to HMP did not result in significantly improved renal function, beneficial effects were found in terms of reduced oxidative stress and energy status. Oxygen addition proofed to be safe and did not show detrimental effects.
BACKGROUND: Hypothermic machine perfusion (HMP) has become standard care in many center's to preserve kidneys donated after circulatory death (DCD). Despite a significant reduction in metabolism at low temperatures, the remaining cellular activity requires oxygen. Because of the role and safety of oxygen during HMP has not been fully clarified, its supply during HMP is not standard yet. This study investigates the effect of administering oxygen during HMP on renal function in a porcine DCD model. METHODS: After 30 minutes of warm ischemia, porcine slaughterhouse kidneys were preserved for 24 hours by means of cold storage (CS), or HMP with Belzer Machine Perfusion Solution supplemented with no oxygen, 21% or 100% oxygen. Next, kidneys were reperfused for 4 hours in a normothermic machine perfusion setup. RESULTS: HMP resulted in significantly better kidney function during normothermic machine perfusion. Thiobarbituric acid-reactive substances, markers of oxidative stress, were significantly lower in HMP preserved kidneys. HMP preserved kidneys showed significantly lower aspartate aminotransferase and lactate dehydrogenase levels compared with kidneys preserved by CS. No differences were found between the HMP groups subjected to different oxygen concentrations. Adenosine triphosphate levels significantly improved during HMP when active oxygenation was applied. CONCLUSIONS: This study showed that preservation of DCD kidneys with HMP is superior to CS. Although the addition of oxygen to HMP did not result in significantly improved renal function, beneficial effects were found in terms of reduced oxidative stress and energy status. Oxygen addition proofed to be safe and did not show detrimental effects.
Authors: B Mesnard; A E Ogbemudia; G Karam; F Dengu; G Hackim; J Rigaud; G Blancho; S Drouin; M O Timsit; J Branchereau Journal: World J Urol Date: 2021-08-25 Impact factor: 3.661
Authors: Leonie H Venema; L Leonie van Leeuwen; Rene A Posma; Harry van Goor; Rutger J Ploeg; Patrick Hannaert; Thierry Hauet; Thomas Minor; Henri G D Leuvenink Journal: Transplantation Date: 2022-08-27 Impact factor: 5.385
Authors: Rianne Schutter; Veerle A Lantinga; Tim L Hamelink; Merel B F Pool; Otis C van Varsseveld; Jan Hendrik Potze; Jan-Luuk Hillebrands; Marius C van den Heuvel; Rudi A J O Dierckx; Henri G D Leuvenink; Cyril Moers; Ronald J H Borra Journal: Transpl Int Date: 2021-09 Impact factor: 3.842
Authors: Merel B F Pool; Tim L Hamelink; Harry van Goor; Marius C van den Heuvel; Henri G D Leuvenink; Cyril Moers Journal: PLoS One Date: 2021-05-18 Impact factor: 3.240