Normothermic ex-vivo kidney perfusion improves early DCD graft function compared to hypothermic machine perfusion and static cold storage.

Urbanellis, Peter; Hamar, Matyas; Kaths, J Moritz; Kollmann, Dagmar; Linares, Ivan; Mazilescu, Laura; Ganesh, Sujani; Wiebe, Aryn; Yip, Paul M; John, Rohan; Konvalinka, Ana; Mucsi, Istvan; Ghanekar, Anand; Bagli, Darius J; Robinson, Lisa A; Selzner, Markus

BACKGROUND Better preservation strategies for the storage of DCD grafts are essential to improve graft function and to increase the kidney donor pool. We compared continuous Normothermic Ex Vivo Kidney Perfusion (NEVKP) with hypothermic anoxic machine perfusion (HAMP) and static cold storage (SCS) in a porcine kidney autotransplantation model. METHODS Porcine kidneys were exposed to 30min of warm ischemia and then reimplanted following either 16hr of either SCS, HAMP (LifePort 1.0) or NEVKP prior to autotransplantation (n=5 per group). The contralateral kidney was removed. Animals were followed for 8 days. RESULTS Grafts preserved by NEVKP demonstrated improved function with more rapid recovery compared to HAMP and SCS (mean peak serum creatinine: 3.66+/-1.33mg/dl (postoperative day 1; POD1), 8.82+/-3.17mg/dl (POD2), and 12.90+/-2.19mg/dl (POD3), respectively). The NEVKP group demonstrated significantly increased creatinine clearance calculated on POD3 (63.6+/-19.0ml/min) compared to HAMP (13.5+/-10.3ml/min, p=0.001) and SCS (4.0+/-2.6ml/min,p=0.001). Histopathologic injury scores on POD8 were lower in both perfused groups (NEVKP and HAMP, score: 1-1.5) compared to SCS (score: 1-3, p=0.3), without reaching statistical significance. CONCLUSIONS NEVKP storage significantly improved early kidney function compared to both cold preservation strategies, although HAMP also demonstrates improvement over SCS. NEVKP may represent a novel, superior preservation option for DCD renal grafts compared to conventional hypothermic methods.