Acellular Perfusate is an Adequate Alternative to Packed Red Blood Cells During Normothermic Human Kidney Perfusion
Background. Brief normothermic machine perfusion is increasingly used to assess and recondition grafts before transplant. During normothermic machine perfusion, metabolic activity is typically maintained using red blood cell (RBC)–based solutions. However, the utilization of RBCs creates important l...
| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2024-04-01
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| Series: | Transplantation Direct |
| Online Access: | http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001609 |
| _version_ | 1797243076591222784 |
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| author | Alban Longchamp, MD, PhD Fermin M. Fontan, MD Mohamed M. Aburawi, MD Corey Eymard, MD Negin Karimian, MD, PhD Danielle Detelich, MD Casie Pendexter, BS Stephanie Cronin, MS Thomas Agius, MS Sonal Nagpal, MBA Peony Dutta Banik, BS Shannon N. Tessier, PhD Sinan Ozer, MBA Francis L. Delmonico, MD Korkut Uygun, PhD Heidi Yeh, MD James F. Markmann, MD, PhD |
| author_facet | Alban Longchamp, MD, PhD Fermin M. Fontan, MD Mohamed M. Aburawi, MD Corey Eymard, MD Negin Karimian, MD, PhD Danielle Detelich, MD Casie Pendexter, BS Stephanie Cronin, MS Thomas Agius, MS Sonal Nagpal, MBA Peony Dutta Banik, BS Shannon N. Tessier, PhD Sinan Ozer, MBA Francis L. Delmonico, MD Korkut Uygun, PhD Heidi Yeh, MD James F. Markmann, MD, PhD |
| author_sort | Alban Longchamp, MD, PhD |
| collection | DOAJ |
| description | Background. Brief normothermic machine perfusion is increasingly used to assess and recondition grafts before transplant. During normothermic machine perfusion, metabolic activity is typically maintained using red blood cell (RBC)–based solutions. However, the utilization of RBCs creates important logistical constraints. This study explored the feasibility of human kidney normothermic perfusion using William’s E–based perfusate with no additional oxygen carrier.
Methods. Sixteen human kidneys declined for transplant were perfused with a perfusion solution containing packed RBCs or William’s E medium only for 6 h using a pressure-controlled system. The temperature was set at 37 °C. Renal artery resistance, oxygen extraction, metabolic activity, energy metabolism, and histological features were evaluated.
Results. Baseline donor demographics were similar in both groups. Throughout perfusion, kidneys perfused with William’s E exhibited improved renal flow (P = 0.041) but similar arterial resistance. Lactic acid levels remained higher in kidneys perfused with RBCs during the first 3 h of perfusion but were similar thereafter (P = 0.95 at 6 h). Throughout perfusion, kidneys from both groups exhibited comparable behavior regarding oxygen consumption (P = 0.41) and reconstitution of ATP tissue concentration (P = 0.55). Similarly, nicotinamide adenine dinucleotide levels were preserved during perfusion. There was no evidence of histological damage caused by either perfusate.
Conclusions. In human kidneys, William’s E medium provides a logistically convenient, off-the-shelf alternative to packed RBCs for up to 6 h of normothermic machine perfusion. |
| first_indexed | 2024-04-24T18:49:22Z |
| format | Article |
| id | doaj.art-396aa870c24442cab2483459c99fec7e |
| institution | Directory Open Access Journal |
| issn | 2373-8731 |
| language | English |
| last_indexed | 2024-04-24T18:49:22Z |
| publishDate | 2024-04-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Transplantation Direct |
| spelling | doaj.art-396aa870c24442cab2483459c99fec7e2024-03-27T03:43:31ZengWolters KluwerTransplantation Direct2373-87312024-04-01104e160910.1097/TXD.0000000000001609202404000-00011Acellular Perfusate is an Adequate Alternative to Packed Red Blood Cells During Normothermic Human Kidney PerfusionAlban Longchamp, MD, PhD0Fermin M. Fontan, MD1Mohamed M. Aburawi, MD2Corey Eymard, MD3Negin Karimian, MD, PhD4Danielle Detelich, MD5Casie Pendexter, BS6Stephanie Cronin, MS7Thomas Agius, MS8Sonal Nagpal, MBA9Peony Dutta Banik, BS10Shannon N. Tessier, PhD11Sinan Ozer, MBA12Francis L. Delmonico, MD13Korkut Uygun, PhD14Heidi Yeh, MD15James F. Markmann, MD, PhD161 Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.1 Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.1 Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.1 Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.1 Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.2 Department of Surgery, Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.2 Department of Surgery, Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.2 Department of Surgery, Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.1 Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.2 Department of Surgery, Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.2 Department of Surgery, Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.2 Department of Surgery, Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.2 Department of Surgery, Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.1 Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.1 Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.1 Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.1 Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.Background. Brief normothermic machine perfusion is increasingly used to assess and recondition grafts before transplant. During normothermic machine perfusion, metabolic activity is typically maintained using red blood cell (RBC)–based solutions. However, the utilization of RBCs creates important logistical constraints. This study explored the feasibility of human kidney normothermic perfusion using William’s E–based perfusate with no additional oxygen carrier. Methods. Sixteen human kidneys declined for transplant were perfused with a perfusion solution containing packed RBCs or William’s E medium only for 6 h using a pressure-controlled system. The temperature was set at 37 °C. Renal artery resistance, oxygen extraction, metabolic activity, energy metabolism, and histological features were evaluated. Results. Baseline donor demographics were similar in both groups. Throughout perfusion, kidneys perfused with William’s E exhibited improved renal flow (P = 0.041) but similar arterial resistance. Lactic acid levels remained higher in kidneys perfused with RBCs during the first 3 h of perfusion but were similar thereafter (P = 0.95 at 6 h). Throughout perfusion, kidneys from both groups exhibited comparable behavior regarding oxygen consumption (P = 0.41) and reconstitution of ATP tissue concentration (P = 0.55). Similarly, nicotinamide adenine dinucleotide levels were preserved during perfusion. There was no evidence of histological damage caused by either perfusate. Conclusions. In human kidneys, William’s E medium provides a logistically convenient, off-the-shelf alternative to packed RBCs for up to 6 h of normothermic machine perfusion.http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001609 |
| spellingShingle | Alban Longchamp, MD, PhD Fermin M. Fontan, MD Mohamed M. Aburawi, MD Corey Eymard, MD Negin Karimian, MD, PhD Danielle Detelich, MD Casie Pendexter, BS Stephanie Cronin, MS Thomas Agius, MS Sonal Nagpal, MBA Peony Dutta Banik, BS Shannon N. Tessier, PhD Sinan Ozer, MBA Francis L. Delmonico, MD Korkut Uygun, PhD Heidi Yeh, MD James F. Markmann, MD, PhD Acellular Perfusate is an Adequate Alternative to Packed Red Blood Cells During Normothermic Human Kidney Perfusion Transplantation Direct |
| title | Acellular Perfusate is an Adequate Alternative to Packed Red Blood Cells During Normothermic Human Kidney Perfusion |
| title_full | Acellular Perfusate is an Adequate Alternative to Packed Red Blood Cells During Normothermic Human Kidney Perfusion |
| title_fullStr | Acellular Perfusate is an Adequate Alternative to Packed Red Blood Cells During Normothermic Human Kidney Perfusion |
| title_full_unstemmed | Acellular Perfusate is an Adequate Alternative to Packed Red Blood Cells During Normothermic Human Kidney Perfusion |
| title_short | Acellular Perfusate is an Adequate Alternative to Packed Red Blood Cells During Normothermic Human Kidney Perfusion |
| title_sort | acellular perfusate is an adequate alternative to packed red blood cells during normothermic human kidney perfusion |
| url | http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001609 |
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