PMC6917615_01
(A) Ischemia-free kidney transplant procedure. The diagram shows procurement, preservation, and implantation of the donor kidney without cessation of blood supply using normothermic machine perfusion. (B) Normothermic machine perfusion device, Liver Assist (Organ Assist, Groningen, the Netherlands). (C) Donor kidney circuit on the organ reservoir of the NMP device.
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F1
Figure 1A shows the technical details of the procedure. Assist device (Organ Assist, Groningen, the Netherlands, Figure 1B). A straight 20Fr cannula was inserted into the infrarenal AA of the donor. After the circuit of in vivo NMP was established, the right kidney was harvested and moved to the organ reservoir for ex vivo NMP (Figure 1C).
Normothermic machine perfusion and allograft viability. (A) Arterial flow rates and pressure. (B) Creatinine (Crea) and urea concentration in the perfusate. (C) Volume of urine production during machine perfusion. (D) pH values and specific gravity levels of the urine produced before procurement, during machine perfusion, and post-reperfusion.
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F2
The perfusion pressure (52-70 mmHg) and flow (130-184 mL/min) were stable during the whole procedure (Figure 2A). The creatinine and urea levels in the perfusate were stable and low (Figure 2B). The kidney graft continued to produce urine during the whole procedure (Figure 2C). The pH values and specific gravity of the urine produced before procurement were comparable to those produced during NMP and after reperfusion (Figure 2D).
PMC6917615_02
Post-transplant renal function and serum biomarker levels of kidney injury of the recipient. The renal function tests including (A) creatinine (Crea) and (B) estimated glomerular filtration rate (eGFR). The serum biomarker levels of kidney injury including (C) cystatin C, (D) neutrophil gelatinase-associated lipocalin (NGAL), (E) liver fatty acid-binding protein (L-FABP), (F) kidney injury molecule-1 (KIM-1), and (G) glutathione s-transferase alpha 1 (GSTA1).
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F3
The recipient had immediate graft function, and the serum creatinine levels fell from 1100 mumol/L pre-transplantation to 95 mumol/L on post-operative day (POD) 3 (Figure 3A). The post-transplant estimated glomerular filtration rate (eGFR) increased from 3.99 mL/min/1.73m2 pre-transplantation to 103.28 mL/min/1.73m2 on POD 7 (Figure 3B). The post-transplant level of cystatin C (Cys C) was quite low (1.76 mg/L on POD 1 and 1.26 mg/L on POD 7) (Figure 3C). The levels of other serum kidney injury biomarkers, including neutrophil gelatinase-associated lipocalin (NGAL), liver fatty acid-binding protein (L-FABP), kidney injury molecule-1 (KIM-1), and glutathione s-transferase alpha 1 (GSTA1), all sharply decreased after IFKT (Figures 3D-G).