Exsanguinous metabolic support perfusion - A new strategy to improve graftfunction after kidney transplantation

Background. The compounding damage of warm ischemia (WI) followed by cold p reservation is a major barrier in renal transplantation. Although the relat ive effect of WI is not yet well understood, therapeutic strategies have mo stly focused on minimizing the pathology seen upon reperfusion from the col d. Our study was designed to examine the effect of restoration of renal met abolism by warm perfusion on graft survival and to investigate the compound ing damage of Tm, Methods. Using a known critical canine autotransplantation model (1), kidne ys were exposed to 30 min WI followed by 24 hr cold storage in Viaspan, The y were then either reimplanted directly or first transitioned to 3 hr of wa rm perfusion with an acellular perfusate before reimplantation, Contralater al kidneys were subjected to 0, 30, or 60 min WP; 24 hr cold storage, and 3 hr warm. perfusion, Results. Transplanted kidneys that were warm perfused before reimplantation had both lower 24 hr posttransplant serum creatinine (median of 3.2 vs. 4. 1 mg/dl) and lower peak serum creatinine (median of 4.95 vs. 7.1 mg/dl). Su rvival rate for warm perfused kidneys was 90% (9/10) vs. 73% (8/11). In the contralateral kidneys, metabolism was affected by the compounding damage o f WI, Renal oxygen and glucose consumption diminished significantly whereas vascular resistance and lactate dehydrogenase-release rose significantly w ith increasing WI. Conclusions. The results demonstrate a reduction of reperfusion damage by a n acellular ex vivo restoration of renal metabolism, Furthermore, data from the contralateral kidneys substantiates the relative role of WI on metabol ism in renal transplantation.