Novel Machine Perfusion Device For Preservation Of DCD Kidney Grafts In Pig Transplantation

Objective:The shortage in donor livers has led to increased use of DCD grafts. Increasing incidence of PNF, DGF as well as lower graft survival rate are seen in recipients of DCD kidneytransplantation. Cold preservation could not fulfill the needs of clinical practice in liver transplantation. NMP storage could significantly alleviate the ischemia reperfusion injury of DCD kidney grafts. In this study, we subject to establish a stable, practical NMP system, as well as to investigate the effect and its mechanism of NMP in alleviating the ischemia reperfusion injury of DCD grafts.Methods: 1. NMP system was established with centrifugal, oxygenator, thermostatic incubator, connecting pipes, and etc. We investigate the pressure and flow of renal artery, temperature, as well as the urine production through ex vivo NMP preservation. 2. Pigkidney transplant model was developed using 10 healthy Bama miniature pigs. 3. 10 Bama miniature donor pigs underwent 30-minute warm ischemia and were randomly allocated to two groups. In the group A, kidneys underwent 8-hour NMP preservation. In the group B, kidneys were preserved immediately with cold storage using UW solution for 8 hours. kidney transplantation was performed in both groups. The survival rate, the serum biochemical markers, the histopathological changes were compared between these two groups.Results: 1. The NMP equipment was successfully constructed.2. Experiencing early period of technical training, the 5d survival rate of the recipient pigs was 100%, and no surgical complications were occurred. 3. The 5d survival rate in group A and B was 100% and 20% respectively. the level of TNF-ɑ、Caspas-3、Cr in group A waslower than those of group B(p<0.05), The pathological examination demonstrated that the injury of the kidneys in group A was slighter than that in group B after 8-hour preservation and reperfusion.Conclusion: 1. The NMP equipment was successfully constructed. 2. Pig kidney transplant model was successfully developed, and the successful rate of operation was 100% with good stability and repeatability through technical training. 3. NMP storage could significantly alleviate the ischemia reperfusion injury of pig DCD kidneys.Itsmechanism was that NMP could mimic the physiological environment of organs, maintain the cellular metabolism, reduce the expression of inflammatory cytokines after preservation and reperfusion.