• Julie De Beule, Sam De Craemer, Laurence Verstraeten, Bart Ghesquière, and Ina Jochmans.
• Department of Microbiology, Immunology, and Transplantation, Laboratory of Abdominal Transplantation, Transplantation Research Group, KU Leuven, Leuven, Belgium.
• Ann. Surg. 2024 Jul 1; 280 (1): 156164156-164.

ObjectiveTo investigate whether ischemia alters donor kidney metabolism and whether these changes are associated with organ function.BackgroundAn unmet need in kidney transplantation is the ability to predict posttransplant organ function before transplantation. Key to such viability testing is a profound understanding of the organ's complex biochemistry and how ischemia, inevitable during the transplantation process, influences this.MethodsFirst, metabolic changes in perfusate glucose, lactate, and 20 amino acids, induced by no, 1 hour of warm, or 22 hours of cold ischemia, were investigated during 4-hour perfusion of pig kidneys with autologous whole blood (n = 6/group), simulating the ischemia-reperfusion phase of transplantation. Next, we confirmed similar metabolic changes during normothermic preservation of pigs (n = 3/group; n = 4 for cold ischemia) and discarded human kidneys (n = 6) perfused with a red blood cell-based perfusate.ResultsAt 2 hours of perfusion with autologous whole blood, abundances of 17/20 amino acids were significantly different between groups, reflecting the type of ischemia. Amino acid changes at 15 minutes and 2 hours of perfusion correlated with future kidney function during perfusion. Similar metabolic patterns were observed during perfusion preservation of pig and discarded human donor kidneys, suggesting an opportunity to assess kidney viability before transplantation.ConclusionsPerfusate metabolite changes during normothermic kidney perfusion represent a unique noninvasive opportunity to assess graft viability. These findings now need validation in transplant studies.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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