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Abstract: TH-OR136

Normothermic Ex Vivo Kidney Perfusion Preservation Reliably Improves Extreme Marginal Graft Function Compared with Hypothermic Machine Perfusion

Session Information

Category: Transplantation

  • 1901 Transplantation: Basic

Authors

  • Urbanellis, Peter, University of Toronto, Toronto, Ontario, Canada
  • Kollmann, Dagmar, Medical University of Vienna, Vienna, Austria
  • Linares, Ivan, University Health Network , Toronto, Ontario, Canada
  • John, Rohan, University Health Network , Toronto, Ontario, Canada
  • Mucsi, Istvan, University Health Network, Toronto, Ontario, Canada
  • Konvalinka, Ana, University Health Network, University of Toronto, Toronto, Ontario, Canada
  • Robinson, Lisa, The Hospital for Sick Children, Toronto, Ontario, Canada
  • Selzner, Markus, Toronto General Hospital, Toronto, Ontario, Canada
Background

Normothermic ex-vivo kidney perfusion (NEVKP) is an emerging technique for renal graft preservation. We investigated whether NEVKP promoted improved marginal graft function compared to anoxic hypothermic machine perfusion (HMP) in a model of donation-after-cardiac-death (DCD).

Methods

Kidneys from 30kg-Yorkshire pigs were removed following 120min of warm ischemia (WI). These grafts were preserved with HMP (LifePort1.0, n=7) or NEVKP (n=7) for 8h prior to heterotopic autotransplantation.

Results

During NEVKP, 120min WI grafts cleared perfusion lactate (0h:10.48±0.93mmol/L vs 7h:1.48±0.85mmol/L,p<0.01), had decreasing intra-renal resistance (IRR) (0h:2.26±0.9mmHg/mL/min vs 7h:0.37±0.6mmHg/mL/min,p<0.01), and produced urine. IRR also decreased in HMP (0h:1.71±0.30mmHg/mL/min vs 7h:1.19±0.37mmHg/mL/min, p=0.01). Post-transplant, 120min WI grafts with NEVKP trended towards earlier and decreased serum creatinine (SCr) peak values compared to HMP (POD3:12.29±2.16mg/dL vs POD5:16.62±6.74mg/dL,p=0.13). From POD5-7, the HMP group demonstrated a bimodal distribution in SCr leading to increased variance compared to NEVKP (standard deviation = 6.74, 9.28, 9.38mg/mL vs 5.72, 6.25, 4.75mg/mL, respectively). In the HMP group, 4 of 7 grafts were poor performing with 2 developing renal vein thrombosis. Conversely, only 1 in 7 grafts was poor performing with NEVKP with no evidence of renal vein thrombosis (Figure 1). The consistent improvement in NEVKP vs heterogeneity in HMP was also observed through the variation in creatinine clearance (POD7: 26.31±11.54mL/min vs 16.8±18.9mL/min) and on histological analysis of tubular injury.

Conclusion

Marginal kidney grafts showed reliable improvement in function following 8h of continuous NEVKP compared to HMP where improvement was inconsistent. This suggests NEVKP would be a preferable storage strategy for DCD procured grafts with extended WI times.