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Extra-corporeal normothermic machine perfusion of the porcine kidney: working towards future utilization in Australasia.
Hameed, Ahmer M; Miraziz, Ray; Lu, David B; Warwick, Neil; El-Ayoubi, Ali; Burns, Heather; Chew, Yi Vee; Matthews, Ross; O'Grady, Greg; Yuen, Lawrence; Rogers, Natasha; Pleass, Henry C; Hawthorne, Wayne J.
Affiliation
  • Hameed AM; Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.
  • Miraziz R; Centre for Transplant and Renal Research, Westmead Institute for Medical Research, Sydney, New South Wales, Australia.
  • Lu DB; Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
  • Warwick N; Department of Anaesthesia, Westmead Hospital, Sydney, New South Wales, Australia.
  • El-Ayoubi A; Centre for Transplant and Renal Research, Westmead Institute for Medical Research, Sydney, New South Wales, Australia.
  • Burns H; Department of Anaesthesia, Westmead Hospital, Sydney, New South Wales, Australia.
  • Chew YV; Centre for Transplant and Renal Research, Westmead Institute for Medical Research, Sydney, New South Wales, Australia.
  • Matthews R; Centre for Transplant and Renal Research, Westmead Institute for Medical Research, Sydney, New South Wales, Australia.
  • O'Grady G; Centre for Transplant and Renal Research, Westmead Institute for Medical Research, Sydney, New South Wales, Australia.
  • Yuen L; Department of Veterinary Sciences, Westmead Hospital, Sydney, New South Wales, Australia.
  • Rogers N; Department of Surgery, The University of Auckland, Auckland, New Zealand.
  • Pleass HC; Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.
  • Hawthorne WJ; Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
ANZ J Surg ; 88(5): E429-E434, 2018 May.
Article in En | MEDLINE | ID: mdl-29239091
ABSTRACT

BACKGROUND:

The ongoing supply-demand gap with respect to donor kidneys for transplantation necessitates the increased use of higher kidney donor profile index and/or donation after circulatory death (DCD) kidneys. Machine perfusion (MP) preservation has become increasingly popular as a means to preserve such organs. Human data regarding normothermic kidney MP (NMP) is in its infancy, and such a system has not been established in the Australasian clinical setting.

METHODS:

Modified cardio-pulmonary bypass technology was utilized to develop a viable NMP kidney perfusion system using a porcine DCD model. System development and optimization occurred in two stages, with system components added in each experiment to identify optimal perfusion conditions.

RESULTS:

Device functionality was demonstrated by the successful perfusion of and urine production by, eight porcine kidneys. Urine production diminished in the presence of colloid in the perfusate. Pressure-controlled (compared with flow-controlled) perfusion is preferable as a safe perfusion pressure range can be maintained. More physiologic perfusion conditions are achieved if oxygenation is provided by an oxygen/carbon dioxide mixture compared to 100% oxygen.

CONCLUSION:

A viable and reproducible NMP system was established and tested in porcine kidneys, which was able to simulate graft function extra-corporeally. Further work is required to identify the most optimal perfusion conditions. Prior to its utilization in clinical transplantation, the system should be tested in non-transplanted human kidneys.
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Full text: 1 Collection: 01-internacional Health context: 6_ODS3_enfermedades_notrasmisibles Database: MEDLINE Main subject: Organ Preservation / Perfusion / Kidney Transplantation / Tissue and Organ Harvesting / Extracorporeal Circulation Limits: Animals Country/Region as subject: Oceania Language: En Journal: ANZ J Surg Year: 2018 Document type: Article
Fulltext
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Full text: 1 Collection: 01-internacional Health context: 6_ODS3_enfermedades_notrasmisibles Database: MEDLINE Main subject: Organ Preservation / Perfusion / Kidney Transplantation / Tissue and Organ Harvesting / Extracorporeal Circulation Limits: Animals Country/Region as subject: Oceania Language: En Journal: ANZ J Surg Year: 2018 Document type: Article