Preservation Solutions for Kidney Transplantation: History, Advances and Mechanisms

Abstract

Solid organ transplantation was one of the greatest medical advances during the past few decades. Organ preservation solutions have been applied to diminish ischemic/hypoxic injury during cold storage and improve graft survival. In this article, we provide a general review of the history and advances of preservation solutions for kidney transplantation. Key components of commonly used solutions are listed, and effective supplementations for current available preservation solutions are discussed. At cellular and molecular levels, further insights were provided into the pathophysiological mechanisms of effective ingredients against ischemic/hypoxic renal injury during cold storage. We pay special attention to the cellular and molecular events during transplantation, including ATP depletion, acidosis, mitochondrial dysfunction, oxidative stress, inflammation, and other intracellular mechanisms.

Assessing Kidney Graft Viability and Its Cells Metabolism during Machine Perfusion

“…The basic formula is the presence of an impermeant to counteract edema and provide stability to the cell skeleton as well as a buffer with a balanced electrolyte composition to prevent the accumulation of intracellular acidosis and further minimize cellular swelling. The concentrations of sodium and potassium is variable and according to which electrolyte level is higher, they are classified as extracellular or intracellular, respectively [ 26 ].…”

Djelovanje hladne ishemije tijekom transplantacije bubrega

“…Kontinuiranim radom na očuvanju organa tijekom transplantacije pioniri u tom polju, Belzer i Southard, 80-ih godina prošlog stoljeća razvijaju University of Wisconsin (UW) otopinu. UW otopina i danas se koristi u rutinskoj upotrebi za ispiranje bubrega i čuvanje tkiva tijekom hladne ishemije jer se pokazalo da ima najveći antioksidativni potencijal u odnosu na ostale ispitivane otopine 41 . No usprkos tome nastaje oštećenje tkiva tijekom produženog trajanja hladne ishemije.…”

“…UW otopina ima i nekoliko nedostataka kao što su velika osmolarnost, kratki vijek aktivnosti dodanog glutationa te visoka cijena. Poznavajući mehanizme oštećenja koji nastaju tijekom hladne ishemije UW otopina ipak ne pruža dovoljnu zaštitu tkivu bubrega 41,42 . Najbliža po učinkovitosti UW otopini je Histidin--Triptofan-Ketoglutarat otopina (HTK), razvijena dodavanjem snažnog puferskog sustava, sastavljenog od histidina u kombinaciji s dva supstrata.…”

Early graft function and intrarenal resistant index after kidney transplantation using Biolasol—A new solid organ preservation fluid

“…Nowadays, as a consequence of organ shortage, the utilization of organs procured from extended criteria donors (ECD) is growing, which expands the need for optimal preservation methods. To minimize ischemic damage, preservation solutions have been designed to specifically target the biological processes that occur during the ischemia/hypoxic conditions 4 . Hence, hypothermic solutions limit adenosine triphosphate consumption and inhibit cellular enzymatic activity, reducing the cellular degradation by phospholipid hydrolysis 5 …”

“…Numerous preservation solutions have been developed for cold static storage, including, among others, the widely used University of Wisconsin (UW), histidine–tryptophan–ketoglutarate (HTK) and Institute Georges Lopez‐1 (IGL‐1) solutions. Nevertheless, during the last 2 decades, several other solutions and organ preservation systems were also developed for cold storage preservation of kidneys 4,6 . Biolasol is a newly designed preservation fluid, containing electrolytes, osmotically and oncotically active substances, a buffer system, substances preventing cellular acidosis, compounds serving as energy sources, calcium channel blockers, and antioxidants 7 .…”