Successful Extension of Vascularized Composite Allograft Perfusion Cold Storage to 24 h in a Rat Hindlimb Transplant Model.

Background: Vascularized composite allograft transplantation is a treatment option for complex tissue injuries; however, ischemia reperfusion injury and high acute rejection rates remain a challenge. Hypothermic machine perfusion using acellular storage perfusate is a potential solution. This study evaluated the University of Wisconsin Kidney Preservation Solution-1 (KPS-1) compared with normal saline (NS) for preservation of donor rat hindlimbs subjected to 24 h of ex vivo perfusion cold storage. Methods: Hindlimbs were subjected to 24-h perfusion cold storage with heparinized KPS-1 (n = 6) or heparinized NS (n = 6). Flow, resistance, and pH were measured continuously. At the end of the 24-h period, tissue was collected for histological analysis of edema and apoptosis. Results: KPS-1 perfused limbs showed significantly less edema than the NS group, as evidenced by lower limb weight gain (P < 0.001) and less interfascicular space (P < 0.001). KPS-perfused muscle had significantly less cell death than NS-perfused muscle based on terminal deoxynucleotidyl transferase dUTP nick-end labeling (P < 0.001) and cleaved caspase-3 staining (P = 0.045). During hypothermic machine perfusion, a significant decrease in pH over time was detected in both groups, with a significantly greater decline in pH in the KPS-1 group than in the NS group. There were no significant differences overall and over time in flow rate or vascular resistance between the KPS and NS groups. Conclusions: Perfusion with KPS-1 can successfully extend vascularized composite allograft perfusion cold storage for 24 h in a rat hindlimb model without significant edema or cell death.

Hibernating bears (Ursidae): metabolic magicians of definite interest for the nephrologist.

Muscle loss, osteoporosis, and vascular disease are common in subjects with reduced renal function. Despite intensive research of the underlying risk factors and mechanisms driving these phenotypes, we still lack effective treatment strategies for this underserved patient group. Thus, new approaches are needed to identify effective treatments. We believe that nephrologists could learn much from biomimicry; i.e., studies of nature's models to solve complicated physiological problems and then imitate these fascinating solutions to develop novel interventions. The hibernating bear (Ursidae) should be of specific interest to the nephrologist as they ingest no food or water for months, remaining anuric and immobile, only to awaken with low blood urea nitrogen levels, healthy lean body mass, strong bones, and without evidence for thrombotic complications. Identifying the mechanisms by which bears prevent the development of azotemia, sarcopenia, osteoporosis, and atherosclerosis despite being inactive and anuric could lead to novel interventions for both prevention and treatment of patients with chronic kidney disease.

A Standardized Warm Ischemia Time for the Induction of Injury in Murine Kidney Transplants.

One of the cornerstone research models used in our laboratories is the induction of ischemic injury through cold ischemia followed by warm ischemia to donor kidneys to mimic the clinical realities of transplantation. The experimental design of the present study included bilateral nephrectomies on the day of syngeneic kidney transplant, with serum creatinine measured 24 hours postoperatively to measure acute function. Cold ischemia time in these experiments was always 30 minutes, and warm ischemia time was not standardized but always recorded. It became apparent that some transplanted kidneys that should have displayed injury were producing close to normal serum creatinine levels on postoperative day 1. In reviewing our data, we found a potential correlation between warm ischemia time and serum creatinine, in particular a significant proportion of low serum creatinine results (0.48 ± 0.26 mg/dL vs 1.99 ± 1.11 mg/dL; P < .05) was associated with warm ischemia times that were significantly shorter than our historical average (29.2 ± 2.7 min vs 35.7 ± 2.2 min; P < .05). The kidneys with lower serum creatinine also displayed lower apoptosis and brush border injury scores and fewer tubular casts. Therefore, we concluded that establishing a minimum warm ischemia time was just as important as standardized cold ischemia time to ensure consistent injury in this model.

Revised Arterial Anastomosis for Improving Murine Kidney Transplant Outcomes.

AIM: One of the most challenging research microsurgical techniques is the mouse kidney transplant however, very few laboratories have made use of this important model due to its difficulty. One of the main obstacles to utilizing this procedure is the high incidence of post-operative arterial thrombosis. We believe this is caused by the path in which blood is required to flow from the recipient abdominal aorta, via the donor recipient aorta and on into the renal artery creating a tortuous route and areas of turbulence, which are prone to thrombus formation and failure of the graft. METHODS: We describe revised methods of donor artery recovery, whereby the traditional transection of the donor aorta is replaced with a heel and toe cuff, which is created by dividing the donor abdominal aorta obliquely across the face of the renal arterial ostium, which then provides for an arterial end-to-side anastomosis of a scale similar to that used for the heterotopic heart model. This technique produces an anastomosis that facilitates free blood flow from the recipient abdominal aorta at less than 90° thereby reducing the likelihood of thrombus formation. RESULTS: Utilizing this new technique the incidence of arterial thrombosis has decreased from 35% to 0% (n = 20 and 24, respectively) with no change in ischemia times. CONCLUSION: We describe a revised method of performing the arterial anastomosis during mouse kidney transplantation, which facilitates improved fluid dynamics by straightening the flow path for blood to the graft resulting in significantly reduced thrombus formation, excellent graft function, histology, and post-transplant survival.

Murine Kidney Transplant Technique.

The first mouse kidney transplant technique was published in 1973(1) by the Russell laboratory. Although it took some years for other labs to become proficient in and utilize this technique, it is now widely used by many laboratories around the world. A significant refinement to the original technique using the donor aorta to form the arterial anastomosis instead of the renal artery was developed and reported in 1993 by Kalina and Mottram (2) with a further advancement coming from the same laboratory in 1999 (3). While one can become proficient in this model, a search of the literature reveals that many labs still experience a high proportion of graft loss due to arterial thrombosis. We describe here a technique that was devised in our laboratory that vastly reduces the arterial thrombus reported by others (4,5). This is achieved by forming a heel-and-toe cuff of the donor infra-renal aorta that facilitates a larger anastomosis and straighter blood flow into the kidney.