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ex vivo renal perfusion

S Sachin, M C Rajesh, E K Ramdas
Surgical removal of the kidney tumor outside the body, (ex vivo renal bench surgery) followed by auto transplantation is an emerging and often done procedure to reconstruct the urinary tract. It possesses immense challenges to both the anesthesiologists and the surgeons. The risks are multiplied if you are performing the surgery on a solitary functioning kidney. Here, we are describing the anesthetic management of 70-year-old male post nephrectomy patient undergoing renal auto transplantation by bench surgery...
September 2016: Anesthesia, Essays and Researches
Kai Jiang, Christopher M Ferguson, Behzad Ebrahimi, Hui Tang, Timothy L Kline, Tyson A Burningham, Prassana K Mishra, Joseph P Grande, Slobodan I Macura, Lilach O Lerman
Purpose To test the utility of magnetization transfer imaging in detecting and monitoring the progression of renal fibrosis in mice with unilateral renal artery stenosis. Materials and Methods This prospective study was approved by the Institutional Animal Care and Use Committee. Renal artery stenosis surgery (n = 10) or sham surgery (n = 5) was performed, and the stenotic and contralateral kidneys were studied longitudinally in vivo at baseline and 2, 4, and 6 weeks after surgery. After a 16.4-T magnetic resonance imaging examination, magnetization transfer ratio was measured as an index of fibrosis (guided by parameters selected in preliminary phantom studies)...
October 3, 2016: Radiology
Sarah A Hosgood, Michael L Nicholson
BACKGROUND: The measurement of urinary biomarkers during ex-vivo normothermic kidney perfusion (EVKP) may aid in the assessment of a kidney prior to transplantation. This study measured levels of neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1) and endothelin-1 (ET-1) during EVKP in a series of discarded human kidneys. METHODS: Fifty six kidneys from deceased donors were recruited into the study. Each kidney underwent 60 minutes of EVKP and was scored based on the macroscopic appearance, renal blood flow and urine output...
September 27, 2016: Transplantation
J Moritz Kaths, Jun Yu Cen, Yi Min Chun, Juan Echeverri, Ivan Linares, Sujani Ganesh, Paul Yip, Rohan John, Darius Bagli, Istvan Mucsi, Anand Ghanekar, David Grant, Lisa A Robinson, Markus Selzner
Hypothermic preservation is known to cause renal graft injury, especially in donation after circulatory death (DCD) kidney transplantation. We investigated the impact of cold storage (SCS) vs. short periods of normothermic ex vivo kidney perfusion (NEVKP) after SCS vs. prolonged, continuous NEVKP with near avoidance of SCS on kidney function after transplantation. Following 30 minutes of warm ischemia, kidneys were removed from 30kg Yorkshire pigs and preserved for 16h with: A) 16h SCS, B) 15h SCS + 1h NEVKP, C) 8h SCS + 8h NEVKP, D) 16h NEVKP...
September 20, 2016: American Journal of Transplantation
Karim Hamaoui, Sally Gowers, Martyn Boutelle, Terry Cook, George Hanna, Ara Darzi, Richard Smith, Anthony Dorling, Vassilios Papalois
BACKGROUND: Hypothermic machine organ perfusion (HMP) offers opportunity to manipulate grafts with pharmacological agents prior to transplantation. Pretreating organs with novel cytotopic anti-coagulant peptides that localise to endothelial cell membranes could ameliorate microvascular thrombotic sequelae posttransplantation. We describe experiments testing Thrombalexin (TLN), a novel cell binding thrombin-inhibitor, using porcine and unused human kidneys in a series of ex-vivo normothermic haemo-reperfusion models...
August 5, 2016: Transplantation
J Moritz Kaths, Juan Echeverri, Nicolas Goldaracena, Kristine S Louis, Yi-Min Chun, Ivan Linares, Aryn Wiebe, Daniel B Foltys, Paul M Yip, Rohan John, Istvan Mucsi, Anand Ghanekar, Darius J Bagli, David R Grant, Lisa A Robinson, Markus Selzner
BACKGROUND: Hypothermic kidney storage causes preservation injury and is poorly tolerated by renal grafts. We investigated whether static cold storage (SCS) can be safely replaced with a novel technique of pressure-controlled normothermic ex vivo kidney perfusion (NEVKP) in heart-beating donor kidney transplantation. METHODS: Right kidneys were removed from 30 kg Yorkshire pigs in a model of heart-beating donation and either preserved in cold histidine-tryptophan-ketoglutarate solution for 8 hours (n = 5), or subjected to 8 hours of pressure-controlled NEVKP (n = 5) followed by renal heterotopic autotransplantation...
September 2016: Transplantation
J Moritz Kaths, Juan Echeverri, Yi Min Chun, Jun Yu Cen, Nicolas Goldaracena, Ivan Linares, Luke S Dingwell, Paul Yip, Rohan John, Darius Bagli, Istvan Mucsi, Anand Ghanekar, David Grant, Lisa Robinson, Markus Selzner
BACKGROUND: Donation after circulatory death (DCD) is current clinical practice to increase the donor pool. Deleterious effects on renal graft function are described for hypothermic preservation. Therefore, current research focuses on investigating alternative preservation techniques such as normothermic perfusion. METHODS: We compared continuous pressure-controlled normothermic ex vivo kidney perfusion (NEVKP) with static cold storage (SCS) in a porcine model of DCD autotransplantation...
July 27, 2016: Transplantation
David Penton, Jan Czogalla, Agnieszka Wengi, Nina Himmerkus, Dominique Loffing-Cueni, Monique Carrel, Renuga Devi Rajaram, Olivier Staub, Markus Bleich, Frank Schweda, Johannes Loffing
A high dietary potassium (K(+) ) intake causes a rapid dephosphorylation, and hence inactivation, of the thiazide-sensitive NaCl cotransporter (NCC) in the renal distal convoluted tubule (DCT). Based on experiments in heterologous expression systems, it was proposed that changes in extracellular K(+) concentration ([K(+) ]ex ) modulate NCC phosphorylation via a Cl(-) dependent modulation of the WNK-SPAK/OSR1 kinase pathway. We used the isolated perfused mouse kidney technique and ex vivo preparations of mouse kidney slices to test the physiological relevance of this model on native DCT...
July 25, 2016: Journal of Physiology
S A Hosgood, K Saeb-Parsy, M O Hamed, M L Nicholson
We report the successful transplantation of a pair of human kidneys that were declined for transplantation due to inadequate in-situ perfusion but subsequently transplanted after perfusion and assessment using ex-vivo normothermic perfusion (EVNP). The kidneys were from a 35y male, donation after circulatory death (DCD) donor. Both kidneys were declined by all UK transplant centres. On arrival, the kidneys had significant areas of incomplete clearance of blood from the microcirculation which didn't clear after a further attempt to flush them...
June 7, 2016: American Journal of Transplantation
Cissy Yong, Sarah A Hosgood, Michael L Nicholson
PURPOSE OF REVIEW: Marginal donor kidneys make up a substantial proportion of transplanted kidneys. Nonetheless, they are more susceptible to injury during procurement and preservation. Normothermic perfusion is an alternative method of organ preservation that can be used to improve the quality, resuscitate, assess and potentially repair the organ. This review provides an up-to-date summary of the role of normothermic perfusion in renal transplantation and what we can expect in the future...
June 2016: Current Opinion in Organ Transplantation
Marlène C H Hekman, Otto C Boerman, Mirjam de Weijert, Desirée L Bos, Egbert Oosterwijk, Hans F Langenhuijsen, Peter F A Mulders, Mark Rijpkema
PURPOSE: Antibodies labeled with both a near-infrared fluorescent dye and a radionuclide can be used for tumor-targeted intraoperative dual-modality imaging. Girentuximab is a chimeric monoclonal antibody against carbonic anhydrase IX (CAIX), an antigen expressed in 95% of clear cell renal cell carcinoma (ccRCC). This study aimed to assess the feasibility of targeted dual-modality imaging with (111)In-girentuximab-IRDye800CW using ex vivo perfusion of human tumorous kidneys. EXPERIMENTAL DESIGN: Seven radical nephrectomy specimens from patients with ccRCC were perfused during 11 to 15 hours with dual-labeled girentuximab and subsequently rinsed during 2...
September 15, 2016: Clinical Cancer Research: An Official Journal of the American Association for Cancer Research
Zhongzhong Liu, Zibiao Zhong, Jianan Lan, Mingxia Li, Wei Wang, Jing Yang, Chenwei Tang, Jie Wang, Shaojun Ye, Yan Xiong, Yanfeng Wang, Qifa Ye
Hypothermic machine perfusion (HMP) has been known as an efficient way to improve kidney graft function, but the underlying mechanisms remain unclear. Here, we adopt a rabbit reperfusion mode to investigate the upstream mechanisms of end-ischemic HMP of kidneys from donors after cardiac death (DCD), with static cold storage (CS) as a control. Eighteen New Zealand healthy male rabbits (12 weeks old, with a weight of 3.0 ± 0.2 kg) were randomly divided into three groups: HMP group, CS group, and Normal group (n = 6)...
April 21, 2016: Artificial Organs
Peter W Fan, Jacob Z Chen, M Allan Jaochico, Hank La, Ning Liu, Teresa Mulder, Robert T Cass, Matthew Durk, Kirsten Messick, Nicole Valle, Shannon Liu, Wendy Lee, James J Crawford, Joachim Rudolf, Lesley J Murray, S Cyrus Khojasteh, Matthew Wright
BACKGROUND: Significant under-prediction of in vivo clearance in rat was observed for a potent p21-activated kinase (PAK1) inhibitor, GNE1. OBJECTIVE: Rate-determining (rapid uptake) and rate-limiting (slow excretion) steps in systemic clearance and elimination of GNE1, respectively, were evaluated to better understand the cause of the in vitro-in vivo (IVIV) disconnect. METHODS: A series of in vivo, ex vivo, and in vitro experiments were carried out: 1) the role of organic cation transporters (Oct or Slc22a) was investigated in transporter knock-out and wild-type animals with or without 1-aminobenzotriazole (ABT) pretreatment; 2) the concentration-dependent hepatic extraction ratio was determined in isolated perfused rat liver; and 3) excreta were collected from both bile duct cannulated and non-cannulated rats after intravenous injection...
2016: Drug Metabolism Letters
Guillermo A Herrera, Elba A Turbat-Herrera, Jiamin Teng
BACKGROUND: Light chain deposition disease (LCDD) is a model of glomerulosclerosis. The mature lesion of LCDD mimics nodular glomerulosclerosis in diabetic nephropathy. The pathogenetic mechanisms involved are similar in both disorders, though the causative factors are entirely different. This fact highlights the generic response of the mesangium to varied stimuli. In-vitro work has provided much insight into the pathogenesis of glomerulosclerosis in LCDD where the mesangium is the main target for initiation and progression of the disease...
2016: Nephron
Florin Ioan Elec, Ciprian Lucan, Liviu Ghervan, Valentin Munteanu, Silviu Moga, Mihai Suciu, Dan Enache, Alina Elec, Adriana Munteanu, Adrian Barbos, Gheorghita Iacob, Mihai Lucan
INTRODUCTION: With a growing shortage of organs for transplantation, finding ways of increasing the donor organ pool remains of utmost importance. Perfusion machines (PM) have been proven to enhance the potential for kidney transplants to function sooner, last longer, giving patients the opportunity for a better life quality. OBJECTIVE: The aim of this study is to evaluate the relation between the resistance index provided by the PM, the postoperative resistance index measured by Doppler ultrasound and the initial graft outcome...
2014: Clujul Medical (1957)
Sarah A Hosgood, A D Barlow, J Dormer, M L Nicholson
BACKGROUND: Many kidneys are rejected for transplantation due to inadequate in situ perfusion during organ retrieval because of the risk of additional ischaemic injury and microvasculature thrombosis. This study describes the use of ex vivo normothermic perfusion (EVNP) for the resuscitation and assessment of human kidneys that were discarded after inadequate in situ perfusion. METHODS: Twenty-two human kidneys were retrieved but then deemed unsuitable for transplantation, primarily due to inadequate in situ perfusion...
2015: Journal of Translational Medicine
Michael Nicholson, Sarah Hosgood
No abstract text is available yet for this article.
October 2015: Transplantation
S A Hosgood, A D Barlow, J P Hunter, M L Nicholson
BACKGROUND: A significant proportion of kidneys procured for transplantation are discarded because of concerns about their suitability. In this study ex vivo normothermic perfusion (EVNP) was used as a quality assessment device before renal transplantation. METHODS: Seventy-four human kidneys deemed unsuitable for transplantation following retrieval underwent 60 min of EVNP with an oxygenated red cell-based solution at 36°C. Receiver operating characteristic (ROC) curves were used to identify thresholds of renal blood flow and urine output...
October 2015: British Journal of Surgery
J Moritz Kaths, Vinzent N Spetzler, Nicolas Goldaracena, Juan Echeverri, Kristine S Louis, Daniel B Foltys, Mari Strempel, Paul Yip, Rohan John, Istvan Mucsi, Anand Ghanekar, Darius Bagli, Lisa Robinson, Markus Selzner
Kidney transplantation has become a well-established treatment option for patients with end-stage renal failure. The persisting organ shortage remains a serious problem. Therefore, the acceptance criteria for organ donors have been extended leading to the usage of marginal kidney grafts. These marginal organs tolerate cold storage poorly resulting in increased preservation injury and higher rates of delayed graft function. To overcome the limitations of cold storage, extensive research is focused on alternative normothermic preservation methods...
2015: Journal of Visualized Experiments: JoVE
Josef Ehling, Janka Bábíčková, Felix Gremse, Barbara M Klinkhammer, Sarah Baetke, Ruth Knuechel, Fabian Kiessling, Jürgen Floege, Twan Lammers, Peter Boor
Progressive kidney diseases and renal fibrosis are associated with endothelial injury and capillary rarefaction. However, our understanding of these processes has been hampered by the lack of tools enabling the quantitative and noninvasive monitoring of vessel functionality. Here, we used micro-computed tomography (µCT) for anatomical and functional imaging of vascular alterations in three murine models with distinct mechanisms of progressive kidney injury: ischemia-reperfusion (I/R, days 1-56), unilateral ureteral obstruction (UUO, days 1-10), and Alport mice (6-8 weeks old)...
February 2016: Journal of the American Society of Nephrology: JASN
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