Impact of an intra-abdominal cooling device during open kidney transplantation in pigs

Abstract

BACKGROUND: Transplantation of kidneys from deceased donors is still associated with a high rate of postoperative renal dysfunction. During implantation into the recipient, the kidney rewarms. This second warm ischaemia time, which is not monitored, is harmful especially if prolonged. We recently developed an intra-abdominal cooling device that efficiently prevents kidney rewarming during robotic transplantation, and prevents ischaemiareperfusion injuries. We tested the benefits of this cooling device during open kidney transplantation in pigs. METHODS: Kidneys were procured from large pigs by open bilateral nephrectomy. Following procurement, kidneys were flushed with 4°C Institut Georges Lopez-1 preservation solution, and placed on ice. Animals then underwent double sequential autologous open renal transplantation with (n = 7) and without (n = 6) intra-abdominal cooling.RESULTS: Mean anastomosis time was similar between groups (43.9 ± 13 minutes). At reperfusion, the renal cortex temperature was lower in the group with cooling (4.3 ± 1.1°C vs 26.5 ± 5.5°C, p <0.001). The cooled kidneys tended to be protected from injury, including some histopathological ischaemia-reperfusion lesions. With the device, kidneys had a better immediate postoperative urine output (p = 0.05). CONCLUSION:Our results indicate that the intra-abdominal cooling device significantly reduced second warm ischaemic time during transplantation, is technically safe and does not prolong anastomotic time.

Ex Vivo Analysis of Kidney Graft Viability Using 31P Magnetic Resonance Imaging Spectroscopy

“…Although the histological score was not validated in a prospective human cohort, it was previously correlated with the degree of kidney injury. [22][23][24] The clinical use of pMRI might be limited by the time of acquisition (45 min). However, the acquisition was performed during the hypothermic ex vivo perfusion, 27 and the imaging time could be reduced either by reducing spatial encoding resolution or by using advanced method for fast spatial encoding.…”

“…Histopathological analysis score was performed based on those described by Goujon et al 22,23 using Osirix software (www.osirix-viewer.com) and modified as previously described. 22,24 Four different representative fields were assessed and blinded to group assignment. Lesion severity was graded 0-5 according to the following criteria: no abnormality (0), mild lesions affecting, respectively, 1%-10% (1), 10%-25% (2), 25%-50% (3), 50%-75% (4), and >75% (5) of the sample surface.…”

Subnormothermic Ex Vivo Porcine Kidney Perfusion Improves Energy Metabolism: Analysis Using 31P Magnetic Resonance Spectroscopic Imaging

“…49 Moreover, proper assessment of kidney function could not be performed because of local regulation, which did not allow survival surgery. Thus, the histological score, previously correlated with the degree of kidney injury, 10,[24][25][26] was used as a surrogate endpoint of kidney function. Future clinical trials should help determine the benefits of perfusion at 22 °C on postoperative graft function.…”

“…Animals were premedicated and anesthetized as previously described. 24 Animals were kept intubated and ventilated during the procedure. An arterial line was inserted in the internal carotid artery.…”

“…Kidneys were explanted and transplanted back into the same animal (autotransplantation). 24 To mimic circulatory arrest during DCD procurement, renal arteries were crossed clamped for 60 min before collection. Kidneys were then immediately flushed and perfused as described earlier in the ex vivo kidney perfusion section above.…”