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Kidney Week

Abstract: FR-PO1107

Whole Blood vs. Packed Red Blood Cell-Based Perfusate in Normothermic Machine Perfusion of Kidneys

Session Information

  • Transplantation: Basic
    November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

  • 1901 Transplantation: Basic

Authors

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

With a rapidly growing gap between supply and demand for donor kidneys, transplant centres look to utilize extended criteria donors to meet the demand. Normothermic machine perfusion (NMP) is a novel preservation method that offers opportunities for graft evaluation and therapeutic interventions not possible with traditional hypothermic methods. With higher metabolic demand, NMP requires an oxygen carrier for efficient tissue oxygenation, and the most common choice is packed red blood cells or leukocyte depleted blood. We aim to investigate the effects of whole blood compared to packed red blood cell-based NMP perfusate on graft perfusion and inflammation.

Methods

Porcine kidneys were recovered and perfused with our pressure controlled NMP system for 12 hours. The NMP system is primed with a modified plasmalyte (crystalloid) solution and either whole donor blood or washed donor packed red blood cell. Perfusate is supplemented with heparin, glucose, and insulin over time through infusions. Perfusate and urine samples are collected for analysis throughout perfusion.

Results

Both groups experienced comparable mean renal blood flow consistently over 12 hours of perfusion, with a trend showing increased renal blood flow in whole blood perfusates (whole blood: 719+27.5ml/min; packed red blood cell: 639+28.8ml/min). No significant differences in perfusate pH were detected. Pro-inflammatory cytokines TNF-alpha and IL-6 were significantly increased in whole blood compared against packed red blood cell-based perfusate. Anti-inflammatory cytokine IL-10 was also significantly increased in whole blood compared to packed red blood cell-based perfusate.

Conclusion

Both whole blood and packed red blood cell-based perfusates demonstrated equivalent perfusion resistance and perfusate biochemistry in a porcine model of kidney normothermic machine perfusion. With the presence of leukocytes in whole blood-based perfusates, there was a significant increase in perfusate cytokines, including both pro-inflammatory cytokines TNF-alpha and IL-6 and anti-inflammatory cytokine IL-10. However, the physiological significance of perfusate cytokine presence still requires further study through histological evaluation and a transplant model with long term follow up.

Funding

  • Private Foundation Support