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Kidney Week

Abstract: FR-PO842

Dextran-Based and Albumin-Based Perfusates in Normothermic Ex Vivo Kidney Perfusion

Session Information

  • Transplantation: Basic
    October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

  • 1801 Transplantation: Basic

Authors

  • Wu, Yilun, University of Alberta, Edmonton, Alberta, Canada
  • Wang, Xiuhua (sue), University of Alberta, Edmonton, Alberta, Canada
  • Freed, Darren, University of Alberta, Edmonton, Alberta, Canada
Background

Kidney transplantation is the definitive treatment for end-stage renal disease. Transplantation is superior to the alternative, dialysis, in survival, quality of life, and cost-savings. However, the gap between kidney donation and demand for donor kidneys is growing, and improved utilization of renal grafts, especially extended criteria donors, is necessary. Normothermic ex vivo kidney perfusion (NEVKP) is a novel method for graft preservation; it maintains metabolism, allows assessment, and allows therapeutic interventions. Currently many NEVKP systems use perfusates composed of a combination of physiological saline, red blood cells, and supplemental source of oncotic pressure and nutrients. Our study examines the effect of dextran-40 based perfusate compared to albumin based perfusates in NEVKP.

Methods

We establish a NEVKP model using porcine kidneys extracted with 10 minutes of warm ischemia perfused using cardiopulmonary bypass equipment. Donor kidney is perfused at normothermia and 60mmHg arterial pressure. Perfusate is composed of donor whole blood and a modified plasmalyte solution containing either 8% dextran-40 or 8% bovine serum albumin. Glucose and insulin are infused.

Results

Dextran and albumin produced similar intra-renal resistance during 12 hours of perfusion. However, dextran based perfusate shows improved urine production rates and urine quality (lower pH, lower/undetectable glucose and calcium) and lower plasma and tissue inflammatory markers (plasma interleukin-6 2.45+0.88ng vs 5.24+0.52ng, plasma tumor necrosis factor-α undetectable in dextran perfusates vs 0.55+0.14ng, tissue expression of toll like receptor-4 77% higher in albumin perfusate group tissues). Neither perfusate groups significantly increase plasma kidney injury molecule-1 (KIM-1), however both perfusate groups show lower tissue KIM-1 compared to tissue from start of perfusion.

Conclusion

With improved perfusion characteristics and reduced inflammatory profile, we believe a dextran based perfusate is superior to albumin based perfusates in NEVKP and that our system provides a viable platform for ex vivo preservation of porcine kidneys and further study of different interventions during ex vivo kidney perfusion.