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Minimising cold ischaemic injury in an experimental model of kidney transplantation

Authors

  • Sarah A. Hosgood,

    1. Department of Infection, Immunity and Inflammation, Transplant Group, University of Leicester, Leicester General Hospital, LE5 4PW, UK
    2. University Hospitals of Leicester, Leicester General Hospital, LE5 4PW, UK
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  • Atul Bagul,

    1. Department of Infection, Immunity and Inflammation, Transplant Group, University of Leicester, Leicester General Hospital, LE5 4PW, UK
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  • Michael L. Nicholson

    1. Department of Infection, Immunity and Inflammation, Transplant Group, University of Leicester, Leicester General Hospital, LE5 4PW, UK
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Sarah A Hosgood, University Hospitals of Leicester, Leicester General Hospital, Gwendolen Road, LE5 4PW, UK. Tel.: +44 (0) 116 2584604; fax +44 (0) 116 2490064; e-mail: sarahhosgood@hotmail.com

Abstract

Eur J Clin Invest 2011; 41 (3): 233–240

Abstract

Background  Cold ischaemic (CI) injury is associated with reduced renal graft function and survival. However, there is little evidence on the benefits of reducing CI injury within a 24 h period in donation after cardiac death (DCD) kidney transplantation.

Methods  Porcine kidneys subjected to 10-min warm ischaemia were retrieved and flushed with hyperosmolar citrate (HOC) preservation solution at 4 °C. They were stored on ice for periods of 2, 6, 18 or 24 h (n = 6). Renal function and injury were assessed during 3 h of ex-vivo reperfusion with oxygenated autologous blood.

Results  Area under the curve (AUC) serum creatinine (Cr) levels were significantly higher in the 18- and 24-h groups and creatinine clearance (CrCl) lower compared to the 2-h group (P = 0·001, 0·003). Urinary biomarkers of ischaemic damage (Endothelin-1, Total nitric oxide) and renal and tubular cell function significantly correlated with the duration of CI time (r = 0·726, 0·642; P ≤ 0·001).

Conclusions  This study demonstrated the progressive effects of CI injury in DCD porcine kidneys over a 24 h hypothermic storage period. This highlights the need to minimise the cold storage period to improve graft function in DCD kidney transplantation.

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