The effect of prolonged of warm ischaemic injury on renal function in an experimental ex vivo normothermic perfusion system

Journal of Translational Medicine

M L Nicholson²  M Patel¹  K Shah¹  Sarah A Hosgood² 

[1] Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK;Department of Surgery, University of Cambridge, NIHR Cambridge Biomedical Research Centre, Cambridge CB2 0QQ, UK

关键词: Reperfusion;    Warm ischaemia;    Transplantation;    Kidney;   

Others  :  1221481
DOI  :  10.1186/s12967-015-0571-4

 received in 2015-04-20, accepted in 2015-06-10,  发布年份 2015

【 摘 要 】

Background

Donation after circulatory death (DCD) kidney transplants inevitably sustain a degree of warm ischaemic injury, which is manifested clinically as delayed graft function. The aim of this study was to define the effects of prolonged periods of warm ischaemic injury on renal function in a normothermic haemoperfused kidney model.

Methods

Porcine kidneys were subjected to 15, 60, 90 (n = 6 per group) and 120 min (n = 4) of in situ warm ischaemia (WI) and then retrieved, flushed with cold preservation fluid and stored in ice for 2 h. Kidneys then underwent 3 h of normothermic reperfusion with a whole blood-based perfusate using an ex vivo circuit developed from clinical grade cardiopulmonary bypass technology.

Results

Creatinine clearance, urine output and fractional excretion of sodium deteriorated sequentially with increasing warm time. Renal function was severely compromised after 90 or 120 min of WI but haemodynamic, metabolic and histological parameters demonstrated the viability of kidneys subjected to prolonged warm ischaemia.

Conclusions

Isolated kidney perfusion using a warm, oxygenated, red cell-based perfusate allows an accurate ex vivo assessment of the potential for recovery from warm ischaemic injury. Prolonged renal warm ischaemic injury caused a severe decrement in renal function but was not associated with tissue necrosis.

【 授权许可】

   
2015 Hosgood et al.

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