Renal hemofiltration prevents metabolic acidosis and reduces inflammation during normothermic machine perfusion of the vascularized composite allograft: a preclinical study
Stone, John P Amin, Kavit R Geraghty, Abbey Kerr, Jak Shaw, Matthew Dabare, Dilan Wong, Jason K Brough, David Entwistle, Timothy R Montero-Fernandez, Angeles
Stone, John P
Amin, Kavit R
Geraghty, Abbey
Kerr, Jak
Shaw, Matthew
Dabare, Dilan
Wong, Jason K
Brough, David
Entwistle, Timothy R
Montero-Fernandez, Angeles
Abstract
Introduction: Recent experimental evidence suggests normothermic machine perfusion of the vascularized composite allograft results in improved preservation compared to static cold storage, with less reperfusion injury in the immediate post-operative period. However, metabolic acidosis is a common feature of vascularized composite allograft perfusion, primarily due to the inability to process metabolic by-products. We evaluated the impact of combined limb-kidney perfusion on markers of metabolic acidosis and inflammation in a porcine model.
Methods: Ten paired pig forelimbs were used for this study, grouped as either limb-only (LO, n = 5) perfusion, or limb-kidney (LK, n = 5) perfusion. Infrared thermal imaging was used to determine homogeneity of perfusion. Lactate, bicarbonate, base, pH, and electrolytes, along with an inflammatory profile generated via the quantification of cytokines and cell-free DNA in the perfusate were recorded.
Results: The addition of a kidney to a limb perfusion circuit resulted in the rapid stabilization of lactate, bicarbonate, base, and pH. Conversely, the LO circuit became progressively acidotic, correlating in a significant increase in pro-inflammatory cytokines. Global perfusion across the limb was more homogenous with LK compared to LO.
Conclusion: The addition of a kidney during limb perfusion results in significant improvements in perfusate biochemistry, with no evidence of metabolic acidosis.
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Date
2021-11-26
Type
Article
Subject
Transplantation, Nephrology/Renal medicine
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Citation
Stone JP, Amin KR, Geraghty A, Kerr J, Shaw M, Dabare D, Wong JK, Brough D, Entwistle TR, Montero-Fernandez A, Fildes JE. Renal hemofiltration prevents metabolic acidosis and reduces inflammation during normothermic machine perfusion of the vascularized composite allograft: A preclinical study. Artif Organs. 2022 Feb;46(2):259-272. doi: 10.1111/aor.14089. Epub 2021 Nov 26.
Journal / Source Title
Artificial Organs
DOI
10.1111/aor.14089
PMID
34662442
Publisher
Wiley-Blackwell
Publisher’s URL
https://onlinelibrary.wiley.com/journal/15251594