Brief Bubble and Intermittent Surface Oxygenation Is a Simple and Effective Alternative for Membrane Oxygenation During Hypothermic Machine Perfusion in Kidneys

Tom Darius; Martial Vergauwen; Matteo Mueller; Selda Aydin; Philipp Dutkowski; Pierre Gianello; Michel Mourad

doi:10.1097/TXD.0000000000001016

Brief Bubble and Intermittent Surface Oxygenation Is a Simple and Effective Alternative for Membrane Oxygenation During Hypothermic Machine Perfusion in Kidneys

Transplant Direct. 2020 Jun 11;6(7):e571. doi: 10.1097/TXD.0000000000001016. eCollection 2020 Jul.

Authors

Tom Darius^{1

2}, Martial Vergauwen², Matteo Mueller³, Selda Aydin⁴, Philipp Dutkowski⁴, Pierre Gianello², Michel Mourad^{1

2}

Affiliations

¹ Department of Surgery, Surgery and Abdominal Transplant Unit, University Clinics Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
² Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Chirurgie Expérimentale et Transplantation, Université Catholique de Louvain, Brussels, Belgium.
³ Department of Surgery and Transplantation, Swiss Hepato-Pancreato-Biliary Center, University Hospital Zurich, Zurich, Switzerland.
⁴ Department of Pathology, University Clinics Saint Luc, Université Catholique de Louvain, Brussels, Belgium.

Abstract

Background: The aim of this feasibility study was to determine an alternative oxygenation technique (easy, cheap, and compatible with air transport) for membrane oxygenation during hypothermic machine perfusion (HMP) to improve early graft function in a porcine ischemia-reperfusion autotransplant model.

Methods: The left kidney of a ±40- kg pig was exposed to 30 minutes of warm ischemia before 22 hours of preservation and autotransplantation. In the experimental group, oxygenation of the perfusate during HMP was obtained by direct bubble and 30-minute surface oxygenation at start and 1-hour end ischemic (n = 4) and outcome measures compared with historical HMP without active oxygenation (n = 6), 22-hour continuous oxygenated HMP (HMPO₂) (n = 8), and 2-hour HMPO₂ + 20-hour HMP (n = 6) using membrane oxygenation in both historical oxygenated control groups.

Results: Brief bubble and 30-minute surface oxygenation of the perfusate effectively maintained supraphysiological Po₂ levels during the first 2 hours of HMP with improved flow dynamics. Although the metabolic profile of the perfusate (ie, flavin mononucleotide) and tissue (ie, glutamate, ATP) after brief O₂ uploading at the start of HMP seemed to be slightly better with the use of a membrane oxygenator compared with bubble and interrupted surface oxygenation, both techniques yielded similar, superior early graft function when compared with HMP without active oxygenation.

Conclusions: The data presented in this feasibility study support the conclusion that brief bubble and intermittent surface oxygenation could be an alternative oxygenation technique during HMP to achieve an improved kidney graft function compared with HMP without active oxygenation and similar functional outcome when compared with membrane HMPO₂.