Exploration on the experience of long-term external normothermic machine perfusion of discarded human kidney for the first time in China

Yang Huang; Shuangjin YU; Haiwei Chen; Guobin WU; Fangze QI; Yanhan Liu; Yuying Yang; Tong Chen; Hehuan Ruan; Tao Zhang; Honghui Chen; Chuanbao Chen; Qiang Zhao; Zhiyong Guo; Guodong Chen; Jiang Qiu; Xiaoshun HE

Return

Exploration on the experience of long-term external normothermic machine perfusion of discarded human kidney for the first time in China

VernacularTitle:国内首例人弃肾长时间体外常温机械灌注经验探索
Author: Yang HUANG ¹ ; Shuangjin YU ; Haiwei CHEN ; Guobin WU ; Fangze QI ; Yanhan LIU ; Yuying YANG ; Tong CHEN ; Hehuan RUAN ; Tao ZHANG ; Honghui CHEN ; Chuanbao CHEN ; Qiang ZHAO ; Zhiyong GUO ; Guodong CHEN ; Jiang QIU ; Xiaoshun HE
Author Information

1. 中山大学附属第一医院器官移植中心，广州　510080
Keywords: Kidney transplantation; Hemoperfusion; Organ preservation; Normothermic machine perfusion; Extended criteria donors
From: Chinese Journal of Nephrology 2022;38(4):329-335
CountryChina
Language:Chinese
Abstract: Objective:To explore the long-term preservation value and repair effect of normothermic machine perfusion (NMP) on clinically discarded kidneys.Methods:A case of clinical discarded donor kidney was collected, and NMP was carried out in vitro for 9 hours with recovered blood. The dynamic changes of renal appearance, blood gas and biochemistry analysis of perfusate and renal pathology were recorded. Results:In the second to fifth hour of NMP, the appearance of renal was pink and ex vivo normothermic perfusion assessment score (EVNP) was grade Ⅰ. While, the sixth hour and beyond of NMP, the appearance of kidney turned to dark red and EVNP was grade Ⅲ. The renal perfusion blood flow maintained above 150 ml/min in the first 6 hours and decreased significantly after that, and at the end, was only 50 ml/min. During the whole process of perfusion, urine output was maintained at about 100 ml/h. PO 2 remained above 100 mmHg in the first 5 hours of perfusion and from the 6th hour, was lower than 80 mmHg and continued to decline, and was close to 0 at the end of perfusion. The results showed that although the K + concentration changes in blood and urine in the first 5 hours of NMP had a good consistency, the lactic acid level had been rising. In addition, there was no significant change in the histopathology at the fourth hour of perfusion compared with that before zero-point puncture, and the fibrinous thrombus in glomeruli was improved compared with that before perfusion. However, at the sixth hour after perfusion and before the end of perfusion, the pathological changes of renal tissue were significantly worse. There were a large of thrombosis in glomerular blood vessels, renal tubular atrophy and acute tubular necrosis. Conclusions:NMP can realize the evaluation of extended criteria donors before transplantation, and it proves the feasibility and repair potential of NMP in kidney to a certain extent. At the same time, NMP also provides a new way to expand the source of donor kidney and to pre-treat organ in vitro.