Functional preservation of the mammalian kidney. VI. Viability assessment of rabbit kidneys perfused at 25 degrees C with dimethyl sulfoxide in RPS-2

Model-Guided Design and Optimization of CPA Perfusion Protocols for Whole Organ Cryopreservation

Vitrification could enable long-term organ preservation, but only after loading high-concentration, potentially toxic cryoprotective agents (CPAs) by perfusion. In this paper, we combine a two-compartment Krogh cylinder model with a toxicity cost function to theoretically optimize the loading of CPA (VMP) in rat kidneys as a model system. First, based on kidney perfusion experiments, we systematically derived the parameters for a CPA transport loading model, including the following: Vb = 86.0% (ra = 3.86 μm), Lp = 1.5 × 10-14 m3/(N·s), ω = 7.0 × 10-13 mol/(N·s), σ = 0.10. Next, we measured the toxicity cost function model parameters as α = 3.12 and β = 9.39 × 10-6. Combining these models, we developed an improved kidney-loading protocol predicted to achieve vitrification while minimizing toxicity. The optimized protocol resulted in shorter exposure (25 min or 18.5% less) than the gold standard kidney-loading protocol for VMP, which had been developed based on decades of empirical practice. After testing both protocols on rat kidneys, we found comparable physical and biological outcomes. While we did not dramatically reduce toxicity, we did reduce the time. As our approach is now validated, it can be used on other organs lacking defined toxicity data to reduce CPA exposure time and provide a rapid path toward developing CPA perfusion protocols for other organs and CPAs.

Cryopreservation of the mammalian kidney. II. Demonstration of immediate ex vivo function after introduction and removal of 7.5 M cryoprotectant

The objective of the present study was to determine whether rabbit kidneys could be perfused with a 7.5 M vitrification solution (VS4, which vitrifies under applied pressure) without loss of function. To answer this question, kidneys were perfused with VS4 using a computer-based machine to gradually raise and lower concentration and then attached to the aorta and vena cava of a perfusor rabbit using an apparatus that permitted renal blood flow and renal function to be measured. About half (6/13) of the kidneys so evaluated resumed substantial immediate function after a transient period of severely reduced blood flow. Loss of function did not occur if cryoprotectant concentration was limited to 3.8 M. The loss of function produced by VS4 could be partially reproduced by artificially limiting blood reflow in control kidneys to simulate the transiently low flows caused by VS4 exposure. These results provide the first evidence that both the parenchyma and the vascular system of a sensitive mammalian organ can survive exposure to a vitrifiable concentration of cryoprotectant.

Effects of four cryoprotectants in combination with two vehicle solutions on cultured vascular endothelial cells

The necessary first step in successful organ cryopreservation will be the maintenance of endothelial cell integrity during perfusion of high concentrations of cryoprotective agents (CPAs). In this report we compare the effects of incubation on cultured porcine endothelial cells at 10 degrees C for 1 h with the CPAs glycerol, dimethyl sulfoxide (Me2SO), ethanediol (EG), and propane-1,2-diol (PG) in the vehicle solutions RPS-2 (high potassium, high glucose) and HP-5NP (low potassium, high sodium), both with and without added colloids. Tritiated adenine uptake and acid phosphatase estimation of cell number were used as indicators of cell viability. HP-5NP was superior to RPS-2 except with Me2SO when the differences in viability were not significant. Adding Haemaccel to HP-5NP improved the results, but adding albumin to RPS-2 was of no significant benefit. Osmotic stress appeared to be the major problem with glycerols use. Beyond 3.0 M the toxicity of Me2SO increased dramatically but it could not be determined if this was osmotic or chemical toxicity. PG was remarkably well tolerated to 3.0 M but a sharp decrease in cell viability beyond this concentration suggests that PG may be most useful with mixtures of other CPAs. Overall, EG appeared to be the least toxic CPA and in the context of vascular preservation warrants further investigation.

Variation of cooling rate and concentration of dimethyl sulfoxide on rabbit kidney function

Rabbit kidney function was assessed in vitro after cryoprotection with either 3 or 4 M dimethyl sulfoxide. The introduction and removal of the cryoprotectant was carried out in a stepwise progressive manner and the removal in a stepwise progressive manner with hypertonic mannitol solutions. This in vitro model can be shown to respond to various ischemic-like states resulting in poor or absent function. Active tubular transport can be demonstrated. It has been used by many authors as an intermediate step prior to the ultimate test of reimplant and contralateral nephrectomy. Variations in the rate of cooling at cryoprotection levels of 3 and 4 M dimethyl sulfoxide concentration (Me2SO) were carried out. In general, at 3 M concentration of Me2SO, creatinine clearance, sodium and glucose reabsorption are preserved with a fair degree of success after cooling to -10, -15, and -20 degrees C in our model, when the rate of cooling to these levels is 1.0 degree C/min. When a cooling rate of 0.5 degree C/min is used, renal function is significantly reduced whether the final temperature is -10, -15, or -20 degrees C. Control rabbit kidneys will tolerate 4 M concentration of Me2SO and give fairly good function. When cooled to -15 or -20 degrees C, there is poor function at 0.1 and 0.5 degrees C/min. Fair function is obtained at the rate of 1 degree C/min to -10 degrees C. Therefore, at cryoprotectant levels of 3 and 4 M Me2SO, kidney function as assayed by in vitro perfusion, is better when the cooling rate is 1.0 degree C/min.

The influence of cooling rate and warming rate on the response of renal cortical slices frozen to -40 degrees C in the presence of 2.1 M cryoprotectant (ethylene glycol, glycerol, or dimethyl sulfoxide)

Renal cortical slices were treated with 2.1 M cryoprotectant in RPS-2 vehicle solution, cooled at one of four rates to -40 degrees C, then immediately warmed at one of four rates to 25 degrees C for determination of the [K+]/[Na+] after a standard incubation period. Results are presented in the form of survival "topographical maps" or surfaces with the x axis representing [K+]/[Na+]; the y axis, cooling rate; and the z axis, warming rate. The rate of temperature change fell in the range of 0.5 to 10 degrees C/min. The results suggest that when RPS-2 vehicle solution is used for 2.1 M cryoprotectants, Me2SO offers the prospect for greatest post-thaw recovery. With this vehicle-cryoprotective agent combination, the greatest post-thaw recovery is attained with cooling-warming combinations of -3, +4, and -0.5, +10 degrees C/min.

The influence of temperature on the function of renal cortical slices frozen in various cryoprotectants

Renal cortical slices were frozen to various subzero temperatures after treatment with 2.1 M of one of three cryoprotectants, dimethyl sulfoxide (Me2SO), ethylene glycol, or glycerol. The effects on tissue [K+]/[Na+] of cooling to these temperatures were tested (using identical procedure times, cooling rates, and warming rates) by holding the slices at each experimental temperature for appropriate periods of time prior to rewarming. The effects of the holding time were assessed by comparison with slices which were cooled and rewarmed with no intermediate holding time. Slices treated with ethylene glycol or glycerol were found to exhibit a continuous decrease in [K+]/[Na+] with lowered temperatures, in contrast to those treated with Me2SO. Slices treated with Me2SO actually experienced a continuous increase in [K+]/[Na+] with lowered temperature (-12 to -33 degrees C). Me2SO does exhibit toxic effects at subzero temperatures. Adverse effects of holding time on viability are seen for Me2SO-treated slices at higher subzero temperatures. These effects were alleviated as the temperature is reduced, suggesting that temperature has a greater effect on survival of renal cortical tissue than Me2SO concentration. However, the toxicity observed at higher subzero temperatures is expected to be of importance, particularly for slowly cooled tissues which are exposed to these temperatures for relatively long periods of time.