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Otani M, Ishii D, Iwata H, Satake Y, Okada Y, Toriumi A, Imamura M, Nishikawa Y, Matsuno N. Preservation Efficacy of a Quercetin and Sucrose Solution for Warm Ischemically Damaged Porcine Liver Grafts. Transplant Proc 2023; 55:2212-2217. [PMID: 37770367 DOI: 10.1016/j.transproceed.2023.07.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 06/08/2023] [Accepted: 07/04/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND The University of Wisconsin (UW) solution is the gold standard for preserving the liver, kidneys, and pancreas. For renal preservation, the addition of the flavonoid, quercetin (QE), to the preservation solution reduces damage to renal tubular cells, and the addition of sucrose (Suc) is also beneficial for preservation. The aim of this study was to investigate the protective effects of QE and Suc on porcine livers in terms of warm and cold injury and to evaluate whether their use improves ischemia-reperfusion (I/R) injury after simple cold storage (CS). METHODS We tested porcine livers procured after 30 minutes of warm ischemia followed by preservation for 6 hours under the following 2 conditions: group 1, preserved with the CS/UW solution (n = 4); group 2, preserved with the CS/UW solution containing Que 33.1 μM and Suc 0.1 M (n = 6). All livers were evaluated using an ex vivo isolated liver reperfusion model with saline-diluted autologous blood. RESULTS Aspartate aminotransferase, alanine aminotransferase, and lactate dehydrogenase levels in group 2 were significantly lower at 30 minutes of reperfusion than in group 1. Furthermore, histologic evaluation by hematoxylin and eosin staining showed significantly fewer morphologic changes in group 2 than in group 1, as indicated by the total Suzuki score. Group 2 also had significantly better scores for sinusoidal congestion and hepatocyte cytoplasmic vacuolization. CONCLUSION Adding Que and Suc to the UW solution can effectively prevent cold injury in livers donated after circulatory death.
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Affiliation(s)
- Masahide Otani
- Department of Surgery, Asahikawa Medical University, Midorigaoka higashi 2-1-1, Asahikawa, Hokkaido 078-8510, Japan; Department of Development of Transplantation Technology, Asahikawa Medical University, Midorigaoka higashi 2-1-1, Asahikawa, Hokkaido 078-8510, Japan.
| | - Daisuke Ishii
- Department of Surgery, Asahikawa Medical University, Midorigaoka higashi 2-1-1, Asahikawa, Hokkaido 078-8510, Japan; Department of Development of Transplantation Technology, Asahikawa Medical University, Midorigaoka higashi 2-1-1, Asahikawa, Hokkaido 078-8510, Japan
| | - Hiroyoshi Iwata
- Department of Surgery, Asahikawa Medical University, Midorigaoka higashi 2-1-1, Asahikawa, Hokkaido 078-8510, Japan; Department of Development of Transplantation Technology, Asahikawa Medical University, Midorigaoka higashi 2-1-1, Asahikawa, Hokkaido 078-8510, Japan
| | - Yoshiyasu Satake
- Department of Development of Transplantation Technology, Asahikawa Medical University, Midorigaoka higashi 2-1-1, Asahikawa, Hokkaido 078-8510, Japan
| | - Yoko Okada
- Department of Development of Transplantation Technology, Asahikawa Medical University, Midorigaoka higashi 2-1-1, Asahikawa, Hokkaido 078-8510, Japan
| | - Asuka Toriumi
- Department of Development of Transplantation Technology, Asahikawa Medical University, Midorigaoka higashi 2-1-1, Asahikawa, Hokkaido 078-8510, Japan
| | - Masashi Imamura
- Business Planning Division, Healthcare Business Headquarters, Ishihara Sangyo Kaisha, Ltd., 3-15, Edobori 1-chome, Nishi-ku, Osaka 550-0002, Japan
| | - Yuji Nishikawa
- Department of Pathology, Asahikawa Medical University, Midorigaoka higashi 2-1-1, Asahikawa, Hokkaido 078-8510, Japan
| | - Naoto Matsuno
- Department of Surgery, Asahikawa Medical University, Midorigaoka higashi 2-1-1, Asahikawa, Hokkaido 078-8510, Japan; Department of Development of Transplantation Technology, Asahikawa Medical University, Midorigaoka higashi 2-1-1, Asahikawa, Hokkaido 078-8510, Japan
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Abdominal Organ Preservation Solutions in the Age of Machine Perfusion. Transplantation 2023; 107:326-340. [PMID: 35939388 DOI: 10.1097/tp.0000000000004269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The past decade has been the foreground for a radical revolution in the field of preservation in abdominal organ transplantation. Perfusion has increasingly replaced static cold storage as the preferred and even gold standard preservation method for marginal-quality organs. Perfusion is dynamic and offers several advantages in comparison with static cold storage. These include the ability to provide a continuous supply of new metabolic substrates, clear metabolic waste products, and perform some degree of organ viability assessment before actual transplantation in the recipient. At the same time, the ongoing importance of static cold storage cannot be overlooked, in particular when it comes to logistical and technical convenience and cost, not to mention the fact that it continues to work well for the majority of transplant allografts. The present review article provides an overview of the fundamental concepts of organ preservation, providing a brief history of static cold preservation and description of the principles behind and basic components of cold preservation solutions. An evaluation of current evidence supporting the use of different preservation solutions in abdominal organ transplantation is provided. As well, the range of solutions used for machine perfusion of abdominal organs is described, as are variations in their compositions related to changing metabolic needs paralleling the raising of the temperature of the perfusate from hypothermic to normothermic range. Finally, appraisal of new preservation solutions that are on the horizon is provided.
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Sharma N, Sharma A, Rai Y, Karwasra R, Khanna K, Nishad K, Bhatt AN, Bhatnagar A, Kakkar D. Protective Effect of Organ Preservation Fluid Supplemented With Nicorandil and Rutin Trihydrate: A Comparative Study in a Rat Model of Renal Ischemia. EXP CLIN TRANSPLANT 2022; 20:569-579. [DOI: 10.6002/ect.2022.0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Gochi M, Kato F, Toriumi A, Kawagoe T, Yotsuya S, Ishii D, Otani M, Nishikawa Y, Furukawa H, Matsuno N. A Novel Preservation Solution Containing Quercetin and Sucrose for Porcine Kidney Transplantation. Transplant Direct 2020; 6:e624. [PMID: 33204822 PMCID: PMC7665254 DOI: 10.1097/txd.0000000000001077] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 08/26/2020] [Accepted: 09/13/2020] [Indexed: 01/20/2023] Open
Abstract
In organ transplantation, the University of Wisconsin (UW) solution has been the gold standard for organ preservation. Quercetin (Que) has numerous antioxidant and anti-inflammatory activities, and sucrose (Suc) may be effective for cold storage (CS). This study aimed to investigate the in vitro protective effect of Que and Suc on cold injury to the kidney and to determine whether Que + Suc could improve ischemia-reperfusion injury during CS and hypothermic oxygenated perfusion (HOPE) in autologous transplantation models. METHODS BHK-21 cells were stored at 4°C for 3 days in UW solution for CS/machine perfusion (CS/MP-UW) with Que (33.1 μM, 3.3 μM, 0.33 μM) and Suc (0.1 M). In a porcine model of renal autologous transplantation, left kidney grafts were preserved under 3 conditions: group 1, CS preservation for 24 hours; group 2, CS preservation for 22 hours and HOPE with CS/MP-UW solution for 2 hours; and group 3, identical preservation as group 2, with Que and Suc added to the solution. Animals were euthanized on day 7 after autologous transplantation. RESULTS After 3 days of CS preservation, the CS/MP-UW solution with Que (33.1 μM, 3.3 μM) and Suc showed significant cell protection against cold injury. In the porcine model of renal autologous transplantation, the last blood Cre level and the blood lipid hydroperoxide on posttransplantation day 2 were significantly different between group 1 and group 3. Moreover, the total endothelial, glomerular, tubular, interstitial (EGTI) histology score in the kidney tissue was also significantly different. Regarding the change in renal resistance in HOPE, the decrease observed in group 3 was significantly larger than that in group 2. CONCLUSIONS Our results suggest that the addition of Que and Suc to a UW solution can improve kidney preservation and could potentially enhance the outcome of kidney transplantation.
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Affiliation(s)
- Mikako Gochi
- Department of Transplantation Technology and Therapeutic Development, Asahikawa Medical University, Hokkaido, Japan
| | - Fuminori Kato
- Pharmaceutical Development Division, Life Science Business Development Headquarters, Ishihara Sangyo Kaisha, Ltd., Osaka, Japan
| | - Asuka Toriumi
- Department of Transplantation Technology and Therapeutic Development, Asahikawa Medical University, Hokkaido, Japan
| | - Tomoko Kawagoe
- Pharmaceutical Development Division, Life Science Business Development Headquarters, Ishihara Sangyo Kaisha, Ltd., Osaka, Japan
| | - Shuichi Yotsuya
- Pharmaceutical Development Division, Life Science Business Development Headquarters, Ishihara Sangyo Kaisha, Ltd., Osaka, Japan
| | - Daisuke Ishii
- Department of Transplantation Technology and Therapeutic Development, Asahikawa Medical University, Hokkaido, Japan
| | - Masahide Otani
- Department of Transplantation Technology and Therapeutic Development, Asahikawa Medical University, Hokkaido, Japan
| | - Yuji Nishikawa
- Department of Pathology, Asahikawa Medical University, Hokkaido, Japan
| | - Hiroyuki Furukawa
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Asahikawa Medical University, Hokkaido, Japan
| | - Naoto Matsuno
- Department of Transplantation Technology and Therapeutic Development, Asahikawa Medical University, Hokkaido, Japan
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Custodiol-N Is Superior to Custodiol ® Solution in Experimental Rat Uterus Preservation. Int J Mol Sci 2020; 21:ijms21218015. [PMID: 33126511 PMCID: PMC7662817 DOI: 10.3390/ijms21218015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/22/2020] [Accepted: 10/27/2020] [Indexed: 01/15/2023] Open
Abstract
Uterus transplantation (UTx) is the first and only available treatment for women with absolute uterine factor infertility. However, clinical application is limited by the lack of organs, ischemia/reperfusion injury, as well as immunosuppression after UTx. Several different preservation solutions are used in experimental and clinical UTx, including Custodiol® solution. Recently, the novel Custodiol-N solution was developed with superior results in organ preservation. However, the solution was not tested yet in UTx. Therefore, the aims of this study were to evaluate the effect of Custodiol-N in uterus prolonged cold preservation time (8 and 24 h), compared to Custodiol® solution. Uterus tissue samples were obtained from adult Sprague Dawley rats (n = 10/group). Cold ischemic injury was estimated by histology, including immunohistochemistry, and biochemical tissue analyses. After 8 h of cold ischemia, higher percentage of tissue edema, necrosis signs and myeloperoxidase expression, as well as lower superoxide dismutase activity were found in Custodiol® compared to Custodiol-N (p < 0.05). These differences were more pronounced after 24 h of cold preservation time (p < 0.05). This study demonstrated that Custodiol-N protects uterus grafts from cold ischemic injury better than standard Custodiol® most likely via inhibition of oxidative stress and tissue edema. It seems that iron chelators in the composition of Custodiol-N play an important protective role against cold ischemia.
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Li S, Huang Z, Li X, Zhao Y, Jiang X, Wen Y, Luo H, Wang L, Guan Q, Cafeeva I, Brooks DE, Nguan CYC, Kizhakkedathu JN, Du C. Evaluation of hyperbranched polyglycerol for cold perfusion and storage of donor kidneys in a pig model of kidney autotransplantation. J Biomed Mater Res B Appl Biomater 2020; 109:853-863. [PMID: 33098184 PMCID: PMC8246781 DOI: 10.1002/jbm.b.34750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/17/2020] [Accepted: 10/06/2020] [Indexed: 02/05/2023]
Abstract
Hyperbranched polyglycerol (HPG) is a biocompatible polyether polymer that is a potential colloid component in a preservation solution for suppressing interstitial edema during cold storage of a donor organ. This study evaluated the outcomes of kidney transplants after cold perfusion and storage with a HPG‐based preservation solution (HPGS) in a pig model of kidney autotransplantation. The left kidneys of farm pigs (weighing 35–45 kg) were perfused with and stored in either cold HPGS or standard UW solution (UWS), followed by transplantation to the right side after right nephrectomy. The survival and function of transplants were determined by the urine output, and serum creatinine (SCr) and blood urea nitrogen (BUN) of recipients. Transplant injury was examined by histological analysis. Here, we showed that there was no significant difference between HPGS and UWS in the prevention of tissue edema, but HPGS was more effective than UWS for initial blood washout of kidney perfusion and for the prevention of cold ischemia injury during cold storage. After autotransplantation, the kidneys preserved with HPGS (HPG group) had better functional recovery than those with UWS (UW group), indicated by significantly more urine output and lower levels of SCr and BUN. The survived grafts in HPG group had less tissue damage than those in UW group. In conclusion, as compared to the UWS the HPGS has less negative impact on kidney cold ischemia during cold storage, resulting in improving immediate functional recovery after transplantation, suggesting that HPG is a promising colloid for donor kidney preservation.
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Affiliation(s)
- Shadan Li
- Department of Urology, The General Hospital of Western Theater Command, Chengdu, China.,Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Zhongli Huang
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Urology, West China Hospital of Sichuan University, Chengdu, China
| | - Xiaowei Li
- Department of Urology, The General Hospital of Western Theater Command, Chengdu, China
| | - Youguang Zhao
- Department of Urology, The General Hospital of Western Theater Command, Chengdu, China
| | - Xin Jiang
- Department of Urology, The General Hospital of Western Theater Command, Chengdu, China
| | - Yang Wen
- Department of Urology, The General Hospital of Western Theater Command, Chengdu, China
| | - Hao Luo
- Department of General Surgery, The General Hospital of Western Theater Command, Chengdu, China
| | - Liang Wang
- Department of Urology, The General Hospital of Western Theater Command, Chengdu, China
| | - Qiunong Guan
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Irina Cafeeva
- Centre for Blood Research, and the Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Donald E Brooks
- Centre for Blood Research, and the Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Chemistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher Y C Nguan
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jayachandran N Kizhakkedathu
- Centre for Blood Research, and the Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Chemistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Caigan Du
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
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Chen Y, Shi J, Xia TC, Xu R, He X, Xia Y. Preservation Solutions for Kidney Transplantation: History, Advances and Mechanisms. Cell Transplant 2019; 28:1472-1489. [PMID: 31450971 PMCID: PMC6923544 DOI: 10.1177/0963689719872699] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Solid organ transplantation was one of the greatest medical advances during the past few
decades. Organ preservation solutions have been applied to diminish ischemic/hypoxic
injury during cold storage and improve graft survival. In this article, we provide a
general review of the history and advances of preservation solutions for kidney
transplantation. Key components of commonly used solutions are listed, and effective
supplementations for current available preservation solutions are discussed. At cellular
and molecular levels, further insights were provided into the pathophysiological
mechanisms of effective ingredients against ischemic/hypoxic renal injury during cold
storage. We pay special attention to the cellular and molecular events during
transplantation, including ATP depletion, acidosis, mitochondrial dysfunction, oxidative
stress, inflammation, and other intracellular mechanisms.
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Affiliation(s)
- Yimeng Chen
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Jian Shi
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Terry C Xia
- The University of Connecticut, Storrs, CT, USA
| | - Renfang Xu
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Xiaozhou He
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Ying Xia
- Shanghai Key Laboratory of Acupuncture Mechanism and Acupoint Function, Fudan University, Shanghai, China
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Carnevale ME, Balaban CL, Guibert EE, Bottai H, Rodriguez JV. Hypothermic machine perfusion versus cold storage in the rescuing of livers from non-heart-beating donor rats. Artif Organs 2013; 37:985-91. [PMID: 24237452 DOI: 10.1111/aor.12235] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The aim of this work was to compare the efficiency of cold storage (CS) and hypothermic machine perfusion (HMP) methods of preserving grafts excised from non-heart-beating donors that had suffered 45 minutes of warm ischemia. We developed a new solution for HMP to use in liver transplantation, based on BES, gluconate, and polyethylene glycol (BGP-HMP solution). After 24 h of HMP or CS, livers were reperfused at 37°C with Krebs-Henseleit solution with added dextran. For both procedures, portal pressure and flow were measured and the intrahepatic resistance (IR) was calculated. The pH oscillations and enzyme activities (LDH, AST, and ALT) were evaluated for the perfusion buffer during normothermic reperfusion. O2 consumption of the liver, glycogen production, and bile flow were also measured during the normothermic reperfusion period. Portal flow and IR showed statistical differences (P < 0.05) between the two groups (n = 5). HMP with BGP-HMP solution resulted in higher values of portal flow and lower IR than CS with HTK solution. Enzyme release after 90 min of reperfusion did not show statistical differences between groups. With regard to bile flow and O2 consumption, livers preserved by both processes were able to produce bile, but livers preserved with HMP were able to take up more O2 than livers preserved by CS.
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Affiliation(s)
- Matías E Carnevale
- Binational Center (Argentina-Italy) for Research in Clinical and Applied Cryobiology (CAIC), National University of Rosario, Rosario, Argentina
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Santos EBD, Koff WJ, Grezzana Filho TDJM, De Rossi SD, Treis L, Bona SR, Pêgas KL, Katz B, Meyer FS, Marroni NAP, Corso CO. Oxidative stress evaluation of ischemia and reperfusion in kidneys under various degrees of hypothermia in rats. Acta Cir Bras 2013; 28:568-73. [DOI: 10.1590/s0102-86502013000800003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 07/15/2013] [Indexed: 11/21/2022] Open
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Wilson CH, Wyrley-Birch H, Vijayanand D, Leea A, Carter NM, Haswell M, Cunningham AC, Talbot D. The influence of perfusion solution on renal graft viability assessment. Transplant Res 2012; 1:18. [PMID: 23369648 PMCID: PMC3629996 DOI: 10.1186/2047-1440-1-18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Accepted: 08/21/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Kidneys from donors after cardiac or circulatory death are exposed to extended periods of both warm ischemia and intra-arterial cooling before organ recovery. Marshall's hypertonic citrate (HOC) and Bretschneider's histidine-tryptophan-ketoglutarate (HTK) preservation solutions are cheap, low viscosity preservation solutions used clinically for organ flushing. The aim of the present study was to evaluate the effects of these two solutions both on parameters used in clinical practice to assess organ viability prior to transplantation and histological evidence of ischemic injury after reperfusion. METHODS Rodent kidneys were exposed to post-mortem warm ischemia, extended intra-arterial cooling (IAC) (up to 2 h) with preservation solution and reperfusion with either Krebs-Hensleit or whole blood in a transplant model. Control kidneys were either reperfused directly after retrieval or stored in 0.9% saline. Biochemical, immunological and histological parameters were assessed using glutathione-S-transferase (GST) enzymatic assays, polymerase chain reaction and mitochondrial electron microscopy respectively. Vascular function was assessed by supplementing the Krebs-Hensleit perfusion solution with phenylephrine to stimulate smooth muscle contraction followed by acetylcholine to trigger endothelial dependent relaxation. RESULTS When compared with kidneys reperfused directly post mortem, 2 h of IAC significantly reduced smooth muscle contractile function, endothelial function and upregulated vascular cellular adhesion molecule type 1 (VCAM-1) independent of the preservation solution. However, GST release, vascular resistance, weight gain and histological mitochondrial injury were dependent on the preservation solution used. CONCLUSIONS We conclude that initial machine perfusion viability tests, including ischemic vascular resistance and GST, are dependent on the perfusion solution used during in situ cooling. HTK-perfused kidneys will be heavier, have higher GST readings and yet reduced mitochondrial ischemic injury when compared with HOC-perfused kidneys. Clinicians should be aware of this when deciding which kidneys to transplant or discard.
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Affiliation(s)
- Colin H Wilson
- Applied Immunobiology Group, University of Sunderland, Sunderland, UK.
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A comparison of hypothermic machine perfusion versus static cold storage in an experimental model of renal ischemia reperfusion injury. Transplantation 2010; 89:830-7. [PMID: 20098357 DOI: 10.1097/tp.0b013e3181cfa1d2] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION There is increasing support for the use of hypothermic machine perfusion (HMP) in an attempt to reduce preservation injury. However, experimental evidence is needed to further examine the effects of HMP on renal ischemia reperfusion injury. METHODS Porcine kidneys were subjected to 10 min of warm ischemia followed by 18 hr of static cold storage with hyperosomolar citrate (HOC), histidine-tryptophan-ketoglutarate (HTK), or University of Wisconsin (UW) solutions or 18 hr HMP with Kidney Perfusion Solution using the Lifeport perfusion system. Renal function, oxidative damage, and morphology were assessed during 3 hr of reperfusion with autologous blood using an isolated organ perfusion system. RESULTS During reperfusion, intrarenal resistance was significantly lower in the HMP group compared with HOC and UW (area under the curve; HMP 3.8+/-1.7, HOC 9.1+/-4.3, UW 7.7+/-2.2, HTK 5.6+/-1.9 mm Hg/min; P=0.006), and creatinine clearance was significantly higher compared with the UW group (area under the curve creatinine clearance; HMP 9.8+/-7.3, HOC 2.2+/-1.7, UW 1.8+/-1.0, HTK 2.1+/-1.8 mL/min/100 g; P=0.004). Tubular function was significantly improved in the HMP group (P<0.05); however, levels of lipid peroxidation were significantly higher (P=0.005). CONCLUSION HMP demonstrated a reduced level of preservation injury compared with the static techniques resulting in improved renal and tubular function and less tubular cell inflammation during reperfusion.
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Kay MD, Hosgood SA, Bagul A, Nicholson ML. Comparison of preservation solutions in an experimental model of organ cooling in kidney transplantation. Br J Surg 2009; 96:1215-21. [DOI: 10.1002/bjs.6681] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Background
Viscous preservation solutions such as University of Wisconsin solution (UW) may be less effective at rapid removal of blood from an organ so that cooling takes longer. This study assessed the temperature changes of kidneys flushed with UW and hyperosmolar citrate (HOC).
Methods
Porcine kidneys were retrieved and flushed with 500 ml UW or HOC at 4 °C while monitoring kidney temperature at depths of 5 and 20 mm. Renal function was measured on an isolated organ preservation system.
Results
The mean(s.d.) rate of temperature fall was slower with UW (at 20 mm: 0·64(0·11) versus 1·01(0·56) °C per min per 100 g; P = 0·016). The perfusion flow rate required to reduce the temperature to less than 10 °C at a depth of 20 mm was lower in the UW group (P = 0·002). Kidneys flushed with HOC gained more weight than those flushed with UW (mean(s.d.) 50(8) versus 7(13) per cent; P = 0·002). Flushing with UW was associated with less histological injury but there were no significant differences in renal function parameters between the groups.
Conclusion
UW cooled kidneys more slowly than HOC, but with no adverse effect on renal function. UW resulted in less oedema and histological injury than HOC.
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Affiliation(s)
- M D Kay
- Transplant Group, Department of Infection, Immunity and Inflammation University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK
| | - S A Hosgood
- Transplant Group, Department of Infection, Immunity and Inflammation University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK
| | - A Bagul
- Transplant Group, Department of Infection, Immunity and Inflammation University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK
| | - M L Nicholson
- Transplant Group, Department of Infection, Immunity and Inflammation University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK
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Figueiredo JF, Bertels IMV, Gontijo JAR. Actin cytoskeletal and functional studies of the proximal convoluted tubules after preservation. Transplant Proc 2008; 40:3311-5. [PMID: 19100379 DOI: 10.1016/j.transproceed.2008.06.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2007] [Revised: 02/08/2008] [Accepted: 06/18/2008] [Indexed: 11/29/2022]
Abstract
BACKGROUND Proximal tubule cells have specialized apical membranes with microvilli that provide an extensive surface area for unidirectional transport of solute from lumen to blood. The major structural solute component is F-actin, which interacts with transmembrane proteins, including ion transport molecules related to normal absorptive and secretory functions. Our study was to evaluate F-actin and fluid absorption (Jv) in proximal tubules after exposure to preservation solutions. METHODS In vitro microperfusion technique and immunohistochemistry analysis. RESULTS 1. Absorptions were similar in 1- and 24-hour-preserved tubules, as well as in fresh tubules. The exception was tubules for 24 hours in Euro-Collins solution, which did not show absorption, suggesting that it was affected. 2. Fluorescence intensity of actin tubules preserved for 1 hour in both solutions showed similar values to each other and to the control group; tubules preserved for 24 hours in both solutions were similar to each other, although statistically different than the control group and those preserved for 1 hour in Belzer (UW) solution. CONCLUSION There were differences among groups in the distribution of F-actin; Jv values were different for 24-hour preservation in each solution, whereas fluorescence intensity was similar in both 24-hour solutions. Thus, actin cytoskeleton was not responsible for it, because 24-hour preservation in UW showed Jv results comparable to the control group.
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Affiliation(s)
- J F Figueiredo
- Organ Preservation Laboratories, Faculty of Medical Sciences, State University of Campimas, Unicamp, Brazil
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14
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Jans F, Ameloot M, Wouters P, Steels P. Na-P(i) cotransporter type I activity causes a transient intracellular alkalinization during ATP depletion in rabbit medullary thick ascending limb cells. Can J Physiol Pharmacol 2008; 86:36-45. [PMID: 18418445 DOI: 10.1139/y07-114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The cellular pathophysiology of renal ischemia-reperfusion injury was investigated in primary cell cultures from rabbit medullary thick ascending limb (MTAL). Metabolic inhibition (MI) was achieved with cyanide and 2-deoxyglucose. Sixty minutes of MI caused a profound but reversible decrease in intracellular concentration of ATP ([ATP]i). Intracellular pH (pHi) first decreased after initiation of MI, followed by a transient alkalinization. When [ATP]i reached its lowest value (<1% of control), the cells slowly acidified to reach a stable pHi of 6.92 after 50 min of MI. In the presence of EIPA (10 micromol/L), the pattern of changes in pHi was unchanged and acidification was not increased, indicating that the Na+/H+ exchangers were inactive during ATP depletion. When inorganic phosphate (P(i)) or Na+ was omitted from the apical solutions during MI, the transient alkalinization was no longer observed and the cytosol slowly acidified. Experiments on Na+-dependent alkalinizations revealed the presence of a Na-P(i) cotransporter in the apical cell membrane. With indirect immunofluorescence, the Na-P(i) cotransporter expressed in these primary cell cultures could be identified as Na-P(i) type I. Although the exact physiological role of Na-P(i) type I still is unresolved, these experiments demonstrate that apical Na-P(i) type I activity is increased at the onset of ATP depletion in MTAL cells.
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Affiliation(s)
- F Jans
- Department of Physiology, Biomedical Research Institute, University of Hasselt, Diepenbeek, Belgium.
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Zhang JL, Rusinek H, Bokacheva L, Lerman LO, Chen Q, Prince C, Oesingmann N, Song T, Lee VS. Functional assessment of the kidney from magnetic resonance and computed tomography renography: impulse retention approach to a multicompartment model. Magn Reson Med 2008; 59:278-88. [PMID: 18228576 DOI: 10.1002/mrm.21489] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A three-compartment model is proposed for analyzing magnetic resonance renography (MRR) and computed tomography renography (CTR) data to derive clinically useful parameters such as glomerular filtration rate (GFR) and renal plasma flow (RPF). The model fits the convolution of the measured input and the predefined impulse retention functions to the measured tissue curves. A MRR study of 10 patients showed that relative root mean square errors by the model were significantly lower than errors for a previously reported three-compartmental model (11.6% +/- 4.9 vs 15.5% +/- 4.1; P < 0.001). GFR estimates correlated well with reference values by (99m)Tc-DTPA scintigraphy (correlation coefficient r = 0.82), and for RPF, r = 0.80. Parameter-sensitivity analysis and Monte Carlo simulation indicated that model parameters could be reliably identified. When the model was applied to CTR in five pigs, expected increases in RPF and GFR due to acetylcholine were detected with greater consistency than with the previous model. These results support the reliability and validity of the new model in computing GFR, RPF, and renal mean transit times from MR and CT data.
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Affiliation(s)
- Jeff L Zhang
- Department of Radiology, New York University School of Medicine, 550 First Avenue, New York, NY 10016, USA
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16
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Abstract
PBS140 offers good cold preservation in renal transplantation and now, crucially, has been shown to promote immediate function following warm ischemia. For a new cold preservation solution to compete with UW solution, improved efficacy and lower price may not be enough. Reducing rates of delayed graft function in organs from non-heart-beating and marginal donors might be the key.
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Affiliation(s)
- R W Jamieson
- Nuffield Department of Surgery, University of Oxford, Oxford, UK
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Ahmad N, Pratt JR, Potts DJ, Lodge JPA. Comparative efficacy of renal preservation solutions to limit functional impairment after warm ischemic injury. Kidney Int 2006; 69:884-93. [PMID: 16407886 DOI: 10.1038/sj.ki.5000063] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In kidney transplantation, cold storage is the dominant modality used to prolong organ viability ex vivo, but is inevitably followed by a period of warm ischemia. Preservation fluids limit tissue damage during the ischemic period, but there is little information on the influence of preservation fluids on the physiologic consequences of warm ischemia alone, or on the comparative ability of such preservation fluids to limit warm ischemic injury. In this study, warm ischemia was induced in rat kidneys by crossclamping the left renal pedicle for 45 min with contralateral nephrectomy. The ischemic kidneys were flushed with Euro-Collins (EC), hyper osmolar citrate (HOC), University of Wisconsin (UW), or phosphate buffered sucrose (PBS)140 solution. Over a period of 2 h after reperfusion, urine and blood samples were collected and physiological parameters related to the function of the postischemic kidneys were assessed. The data show that postischemic renal function can be influenced by the choice of preservation fluid. Essentially, the continued use of EC as a renal preservation solution finds little support in these data, and, while HOC and UW solutions were better able to limit the decline in renal function after warm ischemia than EC, the solution most able to limit functional impairment after warm ischemia was PBS140. This analysis compares the efficacies of the commonly used preservation solutions and could form the basis for future solid-organ transplant studies that may ultimately allow us to propose best-practice guidelines and an optimum platform for improved preservation solutions.
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Affiliation(s)
- N Ahmad
- Department of Organ Transplantation, St James's University Hospital, Leeds LS9 7TF, UK.
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Devalaraja-Narashimha K, Singaravelu K, Padanilam BJ. Poly(ADP-ribose) polymerase-mediated cell injury in acute renal failure. Pharmacol Res 2005; 52:44-59. [PMID: 15911333 DOI: 10.1016/j.phrs.2005.02.022] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2005] [Accepted: 02/01/2005] [Indexed: 01/12/2023]
Abstract
Acute Renal Failure (ARF) is the most costly kidney disease in hospitalized patients and remains as a serious problem in clinical medicine. The mortality rate among ARF patients remains around 50% and no pharmaceutical agents are currently available to improve its clinical outcome. Although several successful therapeutic approaches have been developed in animal models of the disease, translation of the results to clinical ARF remains elusive. Understanding the cellular and molecular mechanisms of vascular and tubular dysfunction in ARF is important for developing acceptable therapeutic interventions. Following an ischemic episode, cells of the affected nephron undergo necrotic and/or apoptotic cell death. Necrotic cell death is widely considered to be a futile process that cannot be modulated by pharmacological means as opposed to apoptosis. However, recent reports from various laboratories including ours indicate that inhibition or absence of poly(ADP)-ribose polymerase (PARP), one of the molecules involved in cell death, provides remarkable protection in disease models such as stroke, myocardial infarction and renal ischemia which are characterized predominantly by necrotic type of cell death. Overactivation of PARP in conditions such as ischemic renal injury leads to cellular depletion of its substrate NAD+ and consequently ATP. The severely compromised cellular energetic state induces acute cell injury and diminishes renal functions. PARP activation also enhances the expression of proinflammatory agents and adhesion molecules in ischemic kidneys. Pharmacological inhibition and gene ablation of PARP-1 decreased energy depletion, inflammatory response and improved renal functions in the setting renal ischemia/reperfusion injury. The biochemical pathways and the cellular and molecular mechanisms mediated by PARP-1 activation in eliciting the energy depletion and inflammatory responses in ischemic kidney are not fully elucidated. Dissecting the molecular mechanisms by which PARP activation contributes to oxidant-induced cell death will provide new strategies to interfere in those pathways to modulate cell death in renal ischemia. The current review evaluates the experimental evidences in animal and cell culture models implicating PARP as a pathophysiological modulator of acute renal failure with particular emphasis on ischemic renal injury.
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