Academic Journal
Urine recirculation improves hemodynamics and enhances function in normothermic kidney perfusion
| العنوان: | Urine recirculation improves hemodynamics and enhances function in normothermic kidney perfusion |
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| المؤلفون: | Weissenbacher, A, Voyce, D, Ceresa, CDL, Soares, MF, Roberts, IS, Hunter, JP, Cook, A, Ploeg, RJ, Coussios, CC, Friend, PJ |
| بيانات النشر: | Lippincott, Williams & Wilkins |
| سنة النشر: | 2021 |
| المجموعة: | Oxford University Research Archive (ORA) |
| الوصف: | Background: The study compares urine recirculation (URC) to urine replacement (UR) with Ringer's lactate in a porcine normothermic kidney machine perfusion (NMP) model using a preclinical prototype device. Methods:Kidney pairs were recovered uninjured (as live-donor nephrectomy) and perfused consecutively. Pig kidneys (n = 10) were allocated to either NMP with URC (n = 5) or NMP with volume replacement (n = 5). Cold ischemia time was either 2 or 27 hours for the first or second perfusion (URC or UR) of a kidney pair. An autologous blood-based perfusate, leukocyte-filtered, was used and NMP performed up to 24 hours. Perfusion parameters, biochemistry/metabolic parameters were monitored and samples collected. Results:Physiological mean arterial pressures and flows were achieved in both groups but were sustainable only with URC. Significantly higher arterial flow was observed with URC (326.7 ± 1.8 versus 242.5 ± 14.3 mL/min, P = 0.001). Perfusate sodium levels were lower with URC, 129.6 ± 0.7 versus 170.3±2.7 mmol/L, P < 0.001). Stable physiological pH levels were only observed with URC. Perfusate lactate levels were lower with URC (2.2 ± 0.1 versus 7.2 ± 0.5 mmol/L, P < 0.001). Furthermore, the hourly rate of urine output was lower with URC and closer to physiological levels (150 versus 548 mL/h, P = 0.008). Normothermic kidney perfusion with URC was associated with longer achievable durations of perfusion: the objective in all experiments was a 24-hour perfusion, but this was not achieved in every case. The mean perfusions were 17.3 ± 9.2 hours with URC versus 5.3 ± 1.3 hours NMP with UR; P = 0.02. There appeared to be no differences in baseline tubular condition with and without URC. Conclusions:URC facilitates long-term kidney NMP in a porcine model. Perfusate homeostasis and stability of renal arterial flow throughout the perfusion period was only achievable with URC, independent of cold ischemia time duration. |
| نوع الوثيقة: | article in journal/newspaper |
| اللغة: | English |
| Relation: | https://ora.ox.ac.uk/objects/uuid:0f620afa-4e99-487c-a7ab-ded304cd7aef; https://doi.org/10.1097/txd.0000000000000985 |
| DOI: | 10.1097/txd.0000000000000985 |
| الاتاحة: | https://doi.org/10.1097/txd.0000000000000985 https://ora.ox.ac.uk/objects/uuid:0f620afa-4e99-487c-a7ab-ded304cd7aef |
| Rights: | info:eu-repo/semantics/openAccess ; CC Attribution (CC BY) |
| رقم الانضمام: | edsbas.49241C93 |
| قاعدة البيانات: | BASE |
| DOI: | 10.1097/txd.0000000000000985 |
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