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Minor T, Malkus L, Zlatev H, Lüer B, von Horn C. Noninvasive measurement of 13Carbon turnover for evaluation of porcine renal grafts during ex vivo machine perfusion. COMMUNICATIONS MEDICINE 2023; 3:192. [PMID: 38129586 PMCID: PMC10739878 DOI: 10.1038/s43856-023-00422-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Kidney transplantation suffers from a shortage of donor organs. Despite this, a lot of grafts are discarded due to inadequate quality. As many kidneys are afflicted by transient filtration failure early after preservation, classical renal function tests are not applicable to differentiate between prospective recovery or continuing deficit of renal function. METHODS Using normothermic machine perfusion as a platform for pre-implantation evaluation of the graft, we present a novel evaluative approach based on the metabolic turnover of 13C-acetate during isolated perfusion. After injection of the tracer, 13CO2 as a metabolic end-product can be quantified by high-precision laser-based spectroscopy in the gas outflow of the oxygenator. Three groups of porcine kidneys with graduated ischemic injury were investigated. RESULTS This quantitative approach is able to discriminate acceptable quality kidneys, most likely to recover within days from poor kidney grafts that are unlikely to regain notable glomerular function with high discriminatory power (area under the ROC curve 0.91; P < 0.001 By contrast, conventional renal function tests are rather ineffective under these circumstances. CONCLUSIONS This assessment method offers the potential to quantitatively assess donor kidney quality using a measurable output, salvaging donors that would otherwise have been discarded.
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Affiliation(s)
- Thomas Minor
- Surgical Research Department, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Laura Malkus
- Surgical Research Department, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Hristo Zlatev
- Surgical Research Department, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Bastian Lüer
- Surgical Research Department, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Charlotte von Horn
- Surgical Research Department, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany.
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Urbanellis P, Mazilescu L, Kollmann D, Linares-Cervantes I, Kaths JM, Ganesh S, Oquendo F, Sharma M, Goto T, Noguchi Y, John R, Konvalinka A, Mucsi I, Ghanekar A, Bagli D, Robinson LA, Selzner M. Prolonged warm ischemia time leads to severe renal dysfunction of donation-after-cardiac death kidney grafts. Sci Rep 2021; 11:17930. [PMID: 34504136 PMCID: PMC8429572 DOI: 10.1038/s41598-021-97078-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 08/09/2021] [Indexed: 12/26/2022] Open
Abstract
Kidney transplantation with grafts procured after donation-after-cardiac death (DCD) has led to an increase in incidence of delayed graft function (DGF). It is thought that the warm ischemic (WI) insult encountered during DCD procurement is the cause of this finding, although few studies have been designed to definitely demonstrate this causation in a transplantation setting. Here, we use a large animal renal transplantation model to study the effects of prolonged WI during procurement on post-transplantation renal function. Kidneys from 30 kg-Yorkshire pigs were procured following increasing WI times of 0 min (Heart-Beating Donor), 30 min, 60 min, 90 min, and 120 min (n = 3-6 per group) to mimic DCD. Following 8 h of static cold storage and autotransplantation, animals were followed for 7-days. Significant renal dysfunction (SRD), resembling clinical DGF, was defined as the development of oliguria < 500 mL in 24 h from POD3-4 along with POD4 serum potassium > 6.0 mmol/L. Increasing WI times resulted in incremental elevation of post-operative serum creatinine that peaked later. DCD120min grafts had the highest and latest elevation of serum creatinine compared to all groups (POD5: 19.0 ± 1.1 mg/dL, p < 0.05). All surviving animals in this group had POD4 24 h urine output < 500 cc (mean 235 ± 172 mL) and elevated serum potassium (7.2 ± 1.1 mmol/L). Only animals in the DCD120min group fulfilled our criteria of SRD (p = 0.003), and their renal function improved by POD7 with 24 h urine output > 500 mL and POD7 serum potassium < 6.0 mmol/L distinguishing this state from primary non-function. In a transplantation survival model, this work demonstrates that prolonging WI time similar to that which occurs in DCD conditions contributes to the development of SRD that resembles clinical DGF.
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Affiliation(s)
- Peter Urbanellis
- Soham and Shaila Ajmera Family Transplant Centre, University of Toronto General Surgery and Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, 585 University Avenue, 11 PMB-178, Toronto, ON, M5G 2N2, Canada.,Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Laura Mazilescu
- Soham and Shaila Ajmera Family Transplant Centre, University of Toronto General Surgery and Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, 585 University Avenue, 11 PMB-178, Toronto, ON, M5G 2N2, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - Dagmar Kollmann
- Soham and Shaila Ajmera Family Transplant Centre, University of Toronto General Surgery and Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, 585 University Avenue, 11 PMB-178, Toronto, ON, M5G 2N2, Canada.,Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Ivan Linares-Cervantes
- Soham and Shaila Ajmera Family Transplant Centre, University of Toronto General Surgery and Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, 585 University Avenue, 11 PMB-178, Toronto, ON, M5G 2N2, Canada.,Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - J Moritz Kaths
- Soham and Shaila Ajmera Family Transplant Centre, University of Toronto General Surgery and Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, 585 University Avenue, 11 PMB-178, Toronto, ON, M5G 2N2, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - Sujani Ganesh
- Soham and Shaila Ajmera Family Transplant Centre, University of Toronto General Surgery and Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, 585 University Avenue, 11 PMB-178, Toronto, ON, M5G 2N2, Canada
| | - Fabiola Oquendo
- Soham and Shaila Ajmera Family Transplant Centre, University of Toronto General Surgery and Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, 585 University Avenue, 11 PMB-178, Toronto, ON, M5G 2N2, Canada
| | - Manraj Sharma
- Soham and Shaila Ajmera Family Transplant Centre, University of Toronto General Surgery and Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, 585 University Avenue, 11 PMB-178, Toronto, ON, M5G 2N2, Canada
| | - Toru Goto
- Soham and Shaila Ajmera Family Transplant Centre, University of Toronto General Surgery and Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, 585 University Avenue, 11 PMB-178, Toronto, ON, M5G 2N2, Canada
| | - Yuki Noguchi
- Soham and Shaila Ajmera Family Transplant Centre, University of Toronto General Surgery and Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, 585 University Avenue, 11 PMB-178, Toronto, ON, M5G 2N2, Canada
| | - Rohan John
- Laboratory Medicine and Pathobiology, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Ana Konvalinka
- Soham and Shaila Ajmera Family Transplant Centre, University of Toronto General Surgery and Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, 585 University Avenue, 11 PMB-178, Toronto, ON, M5G 2N2, Canada.,Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Laboratory Medicine and Pathobiology, Toronto General Hospital, University of Toronto, Toronto, ON, Canada.,Department of Medicine, Division of Nephrology, University Health Network, Toronto, ON, Canada
| | - Istvan Mucsi
- Soham and Shaila Ajmera Family Transplant Centre, University of Toronto General Surgery and Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, 585 University Avenue, 11 PMB-178, Toronto, ON, M5G 2N2, Canada.,Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada.,Department of Medicine, Division of Nephrology, University Health Network, Toronto, ON, Canada
| | - Anand Ghanekar
- Soham and Shaila Ajmera Family Transplant Centre, University of Toronto General Surgery and Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, 585 University Avenue, 11 PMB-178, Toronto, ON, M5G 2N2, Canada
| | - Darius Bagli
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Departments of Surgery (Urology) and Physiology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.,Program in Developmental and Stem Cell Biology, The Hospital For Sick Children Research Institute, Toronto, ON, Canada
| | - Lisa A Robinson
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada. .,Division of Nephrology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada. .,Program in Cell Biology, The Hospital for Sick Children Research Institute, Toronto, ON, Canada.
| | - Markus Selzner
- Soham and Shaila Ajmera Family Transplant Centre, University of Toronto General Surgery and Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, 585 University Avenue, 11 PMB-178, Toronto, ON, M5G 2N2, Canada. .,Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada.
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Lohmann S, Eijken M, Møldrup U, Møller BK, Hunter J, Moers C, Leuvenink H, Ploeg RJ, Clahsen-van Groningen MC, Hoogduijn M, Baan CC, Keller AK, Jespersen B. Ex Vivo Administration of Mesenchymal Stromal Cells in Kidney Grafts Against Ischemia-reperfusion Injury-Effective Delivery Without Kidney Function Improvement Posttransplant. Transplantation 2021; 105:517-528. [PMID: 32956281 DOI: 10.1097/tp.0000000000003429] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Mesenchymal stromal cell (MSC) therapy may improve renal function after ischemia-reperfusion injury in transplantation. Ex vivo renal intraarterial administration is a targeted delivery method, avoiding the lung vasculature, a known barrier for cellular therapies. In a randomized and blinded study, we tested the feasibility and effectiveness of MSC therapy in a donation after circulatory death autotransplantation model to improve posttransplant kidney function, using an ex vivo MSC delivery method similar to the clinical standard procedure of pretransplant cold graft flush. METHODS Kidneys exposed to 75 minutes of warm ischemia and 16 hours of static cold storage were intraarterially infused ex vivo with 10 million male porcine MSCs (Tx-MSC, n = 8) or vehicle (Tx-control, n = 8). Afterwards, the kidneys were autotransplanted after contralateral nephrectomy. Biopsies an hour after reperfusion confirmed the presence of MSCs in the renal cortex. Animals were observed for 14 days. RESULTS Postoperatively, peak plasma creatinine was 1230 and 1274 µmol/L (Tx-controls versus Tx-MSC, P = 0.69). During follow-up, no significant differences over time were detected between groups regarding plasma creatinine, plasma neutrophil gelatinase-associated lipocalin, or urine neutrophil gelatinase-associated lipocalin/creatinine ratio. At day 14, measured glomerular filtration rates were 40 and 44 mL/min, P = 0.66. Renal collagen content and fibrosis-related mRNA expression were increased in both groups but without significant differences between the groups. CONCLUSIONS We demonstrated intraarterial MSC infusion to transplant kidneys as a safe and effective method to deliver MSCs to the graft. However, we could not detect any positive effects of this cell treatment within 14 days of observation.
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Affiliation(s)
- Stine Lohmann
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Marco Eijken
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Ulla Møldrup
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Bjarne K Møller
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - James Hunter
- Nuffield Department of Surgical Sciences, Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Cyril Moers
- Department of Surgery-Organ Donation and Transplantation, University of Medical Center Groningen, Groningen, the Netherlands
| | - Henri Leuvenink
- Department of Surgery-Organ Donation and Transplantation, University of Medical Center Groningen, Groningen, the Netherlands
| | - Rutger J Ploeg
- Nuffield Department of Surgical Sciences, Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | | | - Martin Hoogduijn
- Department of Internal Medicine, Nephrology and Transplantation, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Carla C Baan
- Department of Internal Medicine, Nephrology and Transplantation, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Anna Krarup Keller
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Bente Jespersen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
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