Assessment of hemodynamic and blood parameters that may reflect macroscopic quality of porcine kidneys during normothermic machine perfusion using whole blood

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Abstract

PURPOSE: Using ex vivo normothermic machine perfusion (NMP) with whole blood we assessed marginal porcine kidneys under reperfusion. The aim was to link measureable machine and clinical blood parameters with the currently used visual assessment. This could serve as a baseline for a standardized evaluation score to identify potentially transplantable kidneys in the future.

METHODS: Kidneys and autologous whole blood were procured from slaughterhouse pigs (n = 33) and were perfused for 4 h using NMP. The hemodynamic parameters arterial pressure (AP), renal blood flow (RBF) and intrarenal resistance (IRR) were measured. Activity of aspartate transaminase (AST), gamma-glutamyltransferase (GGT), alkaline phosphatase (ALP), lactate dehydrogenase (LDH) and lactate were assessed in blood at 0/1/2/4 h. Kidneys were grouped into "potentially transplantable" (PT) or "not transplantable" (NT) based on their overall macroscopic appearance after NMP by an experienced physician.

RESULTS: PT-kidneys (n = 20) had a significantly lower IRR and higher RBF than NT-kidneys (n = 13). GGT, ALP and LDH did not differ significantly, but at 4 h, AST was significantly higher in PT-kidneys compared to NT-kidneys. Lactate levels kept increasing during NMP in NT-kidneys and were significantly higher at 1/2/4 h than in PT-kidneys.

CONCLUSION: The immediately assessed macroscopic aspects of examined kidneys correlated with hemodynamic parameters, increased lactate and lower AST in this study. In the future, NMP with whole blood could be a useful tool to extend the donor pool by allowing the assessment of otherwise unknown characteristics of marginal kidneys before transplantation.

Details

Original languageEnglish
Article number471
Number of pages8
JournalWorld journal of urology
Volume42 (2024)
Issue number1
Publication statusPublished - 7 Aug 2024
Peer-reviewedYes

External IDs

PubMedCentral PMC11306647
ORCID /0000-0002-9011-0822/work/165453808
ORCID /0009-0000-8786-5338/work/165453971
Scopus 85200700004

Keywords

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Keywords

  • Alkaline Phosphatase/blood, Animals, Aspartate Aminotransferases/blood, Hemodynamics/physiology, Kidney Transplantation, Kidney/physiology, L-Lactate Dehydrogenase/blood, Organ Preservation/methods, Perfusion, Renal Circulation/physiology, Swine, gamma-Glutamyltransferase/blood, Normotherme Maschinenperfusion, Niere, Funktionsbewertung, Tiermodell, Reperfusion, Vollblut, Schwein

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