Ex Vivo Normothermic Perfusion Induces Donor-Derived Leukocyte Mobilization and Removal Prior to Renal Transplantation
Ex vivo normothermic perfusion offers an alternative method of organ preservation, allowing donor kidneys to be reanimated and evaluated prior to transplantation. Beyond preservation, it can be used to characterize the immunological contribution of the donor kidney in isolation. Furthermore, it has...
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| Format: | Article |
| Language: | English |
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Elsevier
2016-11-01
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| Series: | Kidney International Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2468024916300523 |
| _version_ | 1818609421249413120 |
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| author | John P. Stone Alexandra L. Ball William R. Critchley Triin Major Rebecca J. Edge Kavit Amin Marc J. Clancy James E. Fildes |
| author_facet | John P. Stone Alexandra L. Ball William R. Critchley Triin Major Rebecca J. Edge Kavit Amin Marc J. Clancy James E. Fildes |
| author_sort | John P. Stone |
| collection | DOAJ |
| description | Ex vivo normothermic perfusion offers an alternative method of organ preservation, allowing donor kidneys to be reanimated and evaluated prior to transplantation. Beyond preservation, it can be used to characterize the immunological contribution of the donor kidney in isolation. Furthermore, it has the potential to be used as an immunomodulatory strategy to manipulate donor kidneys prior to transplantation.
Methods: Explanted porcine kidneys underwent 6 hours of perfusion. Sequential perfusate samples were collected and leukocytes characterized via flow cytometry. An inflammatory profile was generated via cytokine quantification. Cell-free DNA was also determined as markers of cell death.
Results: All kidneys functioned within normal parameters and met the criteria for transplantation at the end of perfusion. Throughout perfusion there were continuous increases in pro-inflammatory cytokines, including large concentrations of interferon-γ, suggesting that perfusion drives a significant inflammatory response. Increasing concentrations in cell-free DNA were also observed, suggesting cell death. During perfusion there was a marked cellular diapedesis of T cells, B cells, natural killer (NK) cells, and monocytes from the kidney into the circuit. Minor populations of granulocytes and macrophages were also detected.
Discussion: We demonstrate that ex vivo normothermic perfusion initiates an inflammatory cytokine storm and release of mitochondrial and genomic DNA. This is likely to be responsible for immune cell activation and mobilization into the circuit prior to transplantation. Interestingly this did not have an impact on renal function. These data therefore suggest that normothermic perfusion can be used to immunodeplete and to saturate the pro-inflammatory capacity of donor kidneys prior to transplantation. |
| first_indexed | 2024-12-16T14:58:16Z |
| format | Article |
| id | doaj.art-0d5fb2fcfd27470e9ab4b6357a30ce33 |
| institution | Directory Open Access Journal |
| issn | 2468-0249 |
| language | English |
| last_indexed | 2024-12-16T14:58:16Z |
| publishDate | 2016-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Kidney International Reports |
| spelling | doaj.art-0d5fb2fcfd27470e9ab4b6357a30ce332022-12-21T22:27:22ZengElsevierKidney International Reports2468-02492016-11-011423023910.1016/j.ekir.2016.07.009Ex Vivo Normothermic Perfusion Induces Donor-Derived Leukocyte Mobilization and Removal Prior to Renal TransplantationJohn P. Stone0Alexandra L. Ball1William R. Critchley2Triin Major3Rebecca J. Edge4Kavit Amin5Marc J. Clancy6James E. Fildes7Manchester Collaborative Centre for Inflammation Research (MCCIR), University of Manchester, Manchester, UKManchester Collaborative Centre for Inflammation Research (MCCIR), University of Manchester, Manchester, UKManchester Collaborative Centre for Inflammation Research (MCCIR), University of Manchester, Manchester, UKManchester Collaborative Centre for Inflammation Research (MCCIR), University of Manchester, Manchester, UKManchester Collaborative Centre for Inflammation Research (MCCIR), University of Manchester, Manchester, UKManchester Collaborative Centre for Inflammation Research (MCCIR), University of Manchester, Manchester, UKThe Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UKManchester Collaborative Centre for Inflammation Research (MCCIR), University of Manchester, Manchester, UKEx vivo normothermic perfusion offers an alternative method of organ preservation, allowing donor kidneys to be reanimated and evaluated prior to transplantation. Beyond preservation, it can be used to characterize the immunological contribution of the donor kidney in isolation. Furthermore, it has the potential to be used as an immunomodulatory strategy to manipulate donor kidneys prior to transplantation. Methods: Explanted porcine kidneys underwent 6 hours of perfusion. Sequential perfusate samples were collected and leukocytes characterized via flow cytometry. An inflammatory profile was generated via cytokine quantification. Cell-free DNA was also determined as markers of cell death. Results: All kidneys functioned within normal parameters and met the criteria for transplantation at the end of perfusion. Throughout perfusion there were continuous increases in pro-inflammatory cytokines, including large concentrations of interferon-γ, suggesting that perfusion drives a significant inflammatory response. Increasing concentrations in cell-free DNA were also observed, suggesting cell death. During perfusion there was a marked cellular diapedesis of T cells, B cells, natural killer (NK) cells, and monocytes from the kidney into the circuit. Minor populations of granulocytes and macrophages were also detected. Discussion: We demonstrate that ex vivo normothermic perfusion initiates an inflammatory cytokine storm and release of mitochondrial and genomic DNA. This is likely to be responsible for immune cell activation and mobilization into the circuit prior to transplantation. Interestingly this did not have an impact on renal function. These data therefore suggest that normothermic perfusion can be used to immunodeplete and to saturate the pro-inflammatory capacity of donor kidneys prior to transplantation.http://www.sciencedirect.com/science/article/pii/S2468024916300523ex vivo normothermic perfusionkidney transplantationallorecognitionpassenger leukocytesimmune migration |
| spellingShingle | John P. Stone Alexandra L. Ball William R. Critchley Triin Major Rebecca J. Edge Kavit Amin Marc J. Clancy James E. Fildes Ex Vivo Normothermic Perfusion Induces Donor-Derived Leukocyte Mobilization and Removal Prior to Renal Transplantation Kidney International Reports ex vivo normothermic perfusion kidney transplantation allorecognition passenger leukocytes immune migration |
| title | Ex Vivo Normothermic Perfusion Induces Donor-Derived Leukocyte Mobilization and Removal Prior to Renal Transplantation |
| title_full | Ex Vivo Normothermic Perfusion Induces Donor-Derived Leukocyte Mobilization and Removal Prior to Renal Transplantation |
| title_fullStr | Ex Vivo Normothermic Perfusion Induces Donor-Derived Leukocyte Mobilization and Removal Prior to Renal Transplantation |
| title_full_unstemmed | Ex Vivo Normothermic Perfusion Induces Donor-Derived Leukocyte Mobilization and Removal Prior to Renal Transplantation |
| title_short | Ex Vivo Normothermic Perfusion Induces Donor-Derived Leukocyte Mobilization and Removal Prior to Renal Transplantation |
| title_sort | ex vivo normothermic perfusion induces donor derived leukocyte mobilization and removal prior to renal transplantation |
| topic | ex vivo normothermic perfusion kidney transplantation allorecognition passenger leukocytes immune migration |
| url | http://www.sciencedirect.com/science/article/pii/S2468024916300523 |
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