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Prediction of renal function upon reperfusion by ex situ controlled oxygenated rewarming

BACKGROUND: Post‐transplant function of suboptimal kidney grafts can be improved but not accurately predicted by hypothermic machine perfusion. Therefore, a new concept of ex situ pre‐implantation machine perfusion with controlled rewarming up to subnormothermic temperatures was developed and evalua...

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Autores principales: Minor, Thomas, Sutschet, Katja, Witzke, Oliver, Paul, Andreas, Gallinat, Anja
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6120142/
https://www.ncbi.nlm.nih.gov/pubmed/27718228
http://dx.doi.org/10.1111/eci.12687
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author Minor, Thomas
Sutschet, Katja
Witzke, Oliver
Paul, Andreas
Gallinat, Anja
author_facet Minor, Thomas
Sutschet, Katja
Witzke, Oliver
Paul, Andreas
Gallinat, Anja
author_sort Minor, Thomas
collection PubMed
description BACKGROUND: Post‐transplant function of suboptimal kidney grafts can be improved but not accurately predicted by hypothermic machine perfusion. Therefore, a new concept of ex situ pre‐implantation machine perfusion with controlled rewarming up to subnormothermic temperatures was developed and evaluated. MATERIALS AND METHODS: Porcine kidneys (n = 6/group) were retrieved before or 30 min after cardiac arrest of the donor and subjected to 18 h of static cold storage. In some cases, 90 min of machine‐controlled oxygenated rewarming (COR) was added thereafter. Functional integrity was evaluated in all kidneys by subsequent normothermic reperfusion in vitro. After supplementation of the preservation solution (Custodiol‐N solution + 5 g/L dextran 40) with 10 mg/dL creatinine, ex situ renal function was assessed by monitoring urine output, urinary creatinine and creatinine clearance at 20 °C. Functional integrity was evaluated in all kidneys by normothermic reperfusion. RESULTS: COR resulted in a more than twofold improvement of postreperfusion creatinine clearance, oxygen consumption and enzyme release upon reperfusion, when compared with static cold storage. Predictive discrimination between kidneys with good or impaired function upon reperfusion based on parameters during perfusion at 4 °C was only moderate. This improved significantly at 20 °C. Correlation with renal clearance upon reperfusion was weak for vascular resistance at 8° (r (2) = 0·2) and 20 °C (r (2) = 0·41). Best correlation was found for clearance measurements at 20° (r (2) = 0·81). CONCLUSIONS: Reconditioning by controlled oxygenated rewarming up to 20 °C improves renal function after reperfusion and can be utilized to assess graft integrity of predamaged donor kidneys.
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spelling pubmed-61201422018-09-05 Prediction of renal function upon reperfusion by ex situ controlled oxygenated rewarming Minor, Thomas Sutschet, Katja Witzke, Oliver Paul, Andreas Gallinat, Anja Eur J Clin Invest Original Articles BACKGROUND: Post‐transplant function of suboptimal kidney grafts can be improved but not accurately predicted by hypothermic machine perfusion. Therefore, a new concept of ex situ pre‐implantation machine perfusion with controlled rewarming up to subnormothermic temperatures was developed and evaluated. MATERIALS AND METHODS: Porcine kidneys (n = 6/group) were retrieved before or 30 min after cardiac arrest of the donor and subjected to 18 h of static cold storage. In some cases, 90 min of machine‐controlled oxygenated rewarming (COR) was added thereafter. Functional integrity was evaluated in all kidneys by subsequent normothermic reperfusion in vitro. After supplementation of the preservation solution (Custodiol‐N solution + 5 g/L dextran 40) with 10 mg/dL creatinine, ex situ renal function was assessed by monitoring urine output, urinary creatinine and creatinine clearance at 20 °C. Functional integrity was evaluated in all kidneys by normothermic reperfusion. RESULTS: COR resulted in a more than twofold improvement of postreperfusion creatinine clearance, oxygen consumption and enzyme release upon reperfusion, when compared with static cold storage. Predictive discrimination between kidneys with good or impaired function upon reperfusion based on parameters during perfusion at 4 °C was only moderate. This improved significantly at 20 °C. Correlation with renal clearance upon reperfusion was weak for vascular resistance at 8° (r (2) = 0·2) and 20 °C (r (2) = 0·41). Best correlation was found for clearance measurements at 20° (r (2) = 0·81). CONCLUSIONS: Reconditioning by controlled oxygenated rewarming up to 20 °C improves renal function after reperfusion and can be utilized to assess graft integrity of predamaged donor kidneys. John Wiley and Sons Inc. 2016-10-26 2016-12 /pmc/articles/PMC6120142/ /pubmed/27718228 http://dx.doi.org/10.1111/eci.12687 Text en © 2016 The Authors. European Journal of Clinical Investigation published by John Wiley & Sons Ltd on behalf of Stichting European Society for Clinical Investigation Journal Foundation. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Articles
Minor, Thomas
Sutschet, Katja
Witzke, Oliver
Paul, Andreas
Gallinat, Anja
Prediction of renal function upon reperfusion by ex situ controlled oxygenated rewarming
title Prediction of renal function upon reperfusion by ex situ controlled oxygenated rewarming
title_full Prediction of renal function upon reperfusion by ex situ controlled oxygenated rewarming
title_fullStr Prediction of renal function upon reperfusion by ex situ controlled oxygenated rewarming
title_full_unstemmed Prediction of renal function upon reperfusion by ex situ controlled oxygenated rewarming
title_short Prediction of renal function upon reperfusion by ex situ controlled oxygenated rewarming
title_sort prediction of renal function upon reperfusion by ex situ controlled oxygenated rewarming
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6120142/
https://www.ncbi.nlm.nih.gov/pubmed/27718228
http://dx.doi.org/10.1111/eci.12687
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