• Raphaël Thuillier, Geraldine Allain, Olivier Celhay, William Hebrard, Benoit Barrou, Lionel Badet, Henri Leuvenink, and Thierry Hauet.
• INSERM U1082, Poitiers, France; Université Poitiers, Poitiers, France; CHU Poitiers, Pole UBM, Service de Biochimie, Poitiers, France; FLIRT: Fédération pour L'étude de l'Ischémie Reperfusion en Transplantation, Poitiers, France.
• J. Surg. Res. 2013 Oct 1; 184 (2): 1174-81.

BackgroundDeceased after cardiac death donors (DCDs) represent a valuable source of organs; however, preventing poor outcome is difficult, even with the use of machine perfusion (MP). It is of paramount importance to improve this method. We proposed to evaluate the benefits of active oxygenation during kidney graft hypothermic MP using a novel perfusion machine: Kidney Assist (KA).MethodsWe used a pig model of DCD transplantation in Large White pigs. Cold preservation was performed by conventional non-oxygenated MP (KAnoO2) or oxygenated MP (KA).ResultsIn the first 2 wk post-transplant, KA grafts displayed a lower serum creatinine peak and a faster return to normal levels compared with KAnoO2 animals, translating into a smaller area under the curve. Urinary neutrophil gelatinase-associated lipocalin levels and serum aspartate amino transferase levels were lower in KA animals compared with the non-oxygenated group. These correlated with better chronic function. Longer follow-up of the animals (3 mo) permitted evaluation of chronic outcome lesions. Interstitial fibrosis was reduced in the KA group, and these kidneys also displayed significantly lower levels of vimentin staining. Further histologic investigation also showed a trend toward decreased chronic inflammation in kidneys preserved with oxygen.ConclusionsThis new MP system is efficient in preserving DCD kidneys, greatly enhancing the capacity of the graft to withstand preservation stress and improving outcome. Oxygen delivery during preservation is thus valuable for highly damaged organs and offers an important therapeutic tool for transplant teams faced with decreased quality of donor organs.Copyright © 2013 Elsevier Inc. All rights reserved.

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