Oxygenated hypothermic pulsatile perfusion versus cold static storage for kidneys from non heart-beating donors tested by in-line ATP resynthesis to establish a strategy of preservation

Abstract

Aim: The scarcity of kidneys for transplantation impels an expansion of the donor source to include the use of organs from Maastricht II and Maastricht I non heart-beating donors. The aim of this study was to establish the best method to preserve kidneys from non heart-beating donors (NHBD): cold static storage (CSS) or perfusion. ATP production during kidney preservation has been retained as a measure of their energetic levels and, consequently, their viability. The presence of warm ischemia with both types of preservation was studied. Methods: Porcine kidneys presenting no warm ischemia or 30 minutes of warm ischemia were submitted to immediate oxygenated hypothermic pulsatile perfusion or immediate cold static storage. The study was divided into four groups. ATP resynthesis was measured after 8 h. of perfusion. ATP was assessed by in-line 31P nuclear magnetic resonance spectroscopy (NMRS) during the preservations. Results: Only oxygenated perfusion could restore ATP in organs with warm ischemia. Initial cold static storage seems deleterious on organs having suffered from warm ischemia. Discussion: Only oxygenated perfusion could restore ATP in organs with warm ischemia. Initial cold static storage seems deleterious to organs having suffered from warm ischemia. Oxygenated perfusion must be introduced immediately after kidney removal from non heart-beating donors. In organs without warm ischemia, any kind of preservation is equivalent.