Kidney storage at subzero temperature is safe for porcine kidney autotransplantation: A world first in vivo study

Francisco Calderon Novoa; Tun-Pang Chu; Kaitlin Lees; Sujani Ganesh; Laura Martinez-Arenas; Nicola Pollman; Catherine Parmentier; Masataka Kawamura; Christian Hobeika; Samrat Ray; Emmanuel Nogueira; Rohan John; Aakriti Gupta; Photis Loizides; Tom Allen; Trevor Reichman; Lisa Robinson; Markus Selzner

doi:10.1016/j.ajt.2025.08.033

Kidney storage at subzero temperature is safe for porcine kidney autotransplantation: A world first in vivo study

Am J Transplant. 2025 Sep 9:S1600-6135(25)02947-8. doi: 10.1016/j.ajt.2025.08.033. Online ahead of print.

Authors

Francisco Calderon Novoa¹, Tun-Pang Chu², Kaitlin Lees³, Sujani Ganesh⁴, Laura Martinez-Arenas⁵, Nicola Pollman⁶, Catherine Parmentier⁷, Masataka Kawamura⁸, Christian Hobeika⁹, Samrat Ray⁷, Emmanuel Nogueira¹⁰, Rohan John¹¹, Aakriti Gupta¹², Photis Loizides¹², Tom Allen¹², Trevor Reichman⁷, Lisa Robinson¹³, Markus Selzner⁷

Affiliations

¹ Ajmera Transplant Centre, Toronto General Hospital, Toronto, Canada; Division of Nephrology, The Hospital for Sick Children, Toronto, Canada; Division of General Surgery, University Health Network, Toronto, Canada. Electronic address: francisco.calderonnovoa@uhn.ca.
² Department of Surgery, MacKay Memorial Hospital, Taipei, Taiwan.
³ Ajmera Transplant Centre, Toronto General Hospital, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada.
⁴ Ajmera Transplant Centre, Toronto General Hospital, Toronto, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, Canada.
⁵ Hepatology, Hepatobiliopancreatic Surgery and Transplant Laboratory, Instituto de Investigación Sanitaria La Fe, Universitat Politècnica de València, CIBEREHD, Valencia, Spain.
⁶ Department of General, Visceral and Vascular Surgery, Jena University Hospital, Jena, Germany.
⁷ Ajmera Transplant Centre, Toronto General Hospital, Toronto, Canada; Division of General Surgery, University Health Network, Toronto, Canada.
⁸ Department of Urology, Osaka General Medical Center, Osaka, Japan.
⁹ Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, APHP, Clichy, Paris-Cité University, Paris, France.
¹⁰ Ajmera Transplant Centre, Toronto General Hospital, Toronto, Canada; Division of General Surgery, Fortaleza General Hospital, Ceara, Brazil.
¹¹ Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada; Department of Pathology, University Health Network, Toronto, Canada.
¹² CryoStasis Inc., Ottawa, Ontario.
¹³ Division of Nephrology, The Hospital for Sick Children, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Program in Cell Biology, The Hospital for Sick Children Research Institute, Toronto, Canada.

PMID: 40935342
DOI: 10.1016/j.ajt.2025.08.033

Abstract

Organ shortage continues to limit kidney transplantation worldwide. Subzero storage may harbor the potential for extending cold ischemic times, improving organ sharing, and optimizing graft allocation. However, subzero storage remains challenging, limited by possible freeze-thaw damage. We used a porcine autotransplant model to assess kidney function and injury after brief (5 hours) or prolonged (24-48 hours) subzero storage of grafts, comparing it to classic static cold storage. There was no mortality in the cohort, and subjects were followed for 7 days. Creatinine, blood urea nitrogen, and potassium peak levels and curves were comparable between groups in both brief and prolonged experiments (P > .05). Histologic analysis revealed no evidence suggesting ice crystals had formed, as well as similar injury profiles, suggesting that the subzero preservation process was successful. Creatinine clearance, fractional excretion of sodium, and neutrophil gelatinase-associated lipocalin urinary and serum levels tended to favor subzero preservation in the 24-hour static cold storage experiments, without statistical significance. Although further research is needed to optimize storage protocols and explore the impact of colder temperatures, this study provides promising evidence regarding the safety and feasibility of subzero storage as a method for extending preservation times. Future studies will focus on enhancing preservation solutions for improved outcomes.

Keywords: basic (laboratory) science; cryopreservation; ischemia-reperfusion injury (IRI); kidney transplantation; organ preservation; subzero storage.