The influence of storage temperature during machine perfusion on preservation quality of marginal donor livers

Background

Although non-heart-beating donors have the potential to increase the number of available organs, the livers are used very seldom because of the risk of primary non-function. There is evidence that machine perfusion is able to improve the preservation of marginal organs, and therefore we evaluated in our study the influence of the perfusate temperature during oxygenated machine perfusion on the graft quality.

Methods

Livers from male Wistar rats were harvested after 60-min warm ischemia induced by cardiac arrest. The portal vein was cannulated and the liver flushed with Lifor® (Lifeblood Medical, Inc.) organ preservation solution for oxygenated machine perfusion (MP) at 4, 12 or 21 °C. Other livers were flushed with HTK and stored at 4 °C by conventional cold storage (4 °C-CS). Furthermore two groups with either warm ischemic damage only or without any ischemic damage serve as control groups. After 6 h of either machine perfusion or cold storage all livers were normothermic reperfused with Krebs–Henseleit buffer, and functional as well as structural data were analyzed.

Results

Contrary to livers stored by static cold storage, machine perfused livers showed independently of the perfusate temperature a significantly decreased enzyme release of hepatic transaminases (ALT) during isolated reperfusion. Increasing the machine perfusion temperature to 21 °C resulted in a marked reduction of portal venous resistance and an increased bile production.

Conclusions

Oxygenated machine perfusion improves viability of livers after prolonged warm ischemic damage. Elevated perfusion temperature of 21 °C reconstitutes the hepatic functional capacity better than perfusion at 4 or 12 °C.     

Inhibition of colloid cell swelling in rabbit kidney cortex by disodium glycerophosphate.

Solution based on disodium glycerophosphate have been assessed for ability to inhibit cellular swelling during hypothermic storage of slices of rabbit renal cortex. It was found that slices stored in glycerophosphate media for 3 days gained about 50% of their control weight, whereas control slices stored in chloride based media gained 50% of their control weight after only 2 hr of storage and gained about 128% of their initial weight after 3 days. Electrolyte content of slices stored at 4 °C reflected the change in hydration. When slices were warmed after various storage times, it was found that viability was much better preserved in glycerophosphate saline than in chloride based saline, although the slices stored in glycerophosphate media contained more sodium prior to warming than slices stored in conventional media. Glycerophosphate solutions appear to be suitable for routine use in experiments with renal cortical slices in the vicinity of 0 °C when cell volumes are to be held constant for prolonged periods.     

Suppression of cold ischemic injury in stored kidneys by the antimicrobial peptide bactenecin

BACKGROUND: Cold ischemic injury plays an important role in short- and long-term function of kidneys after transplant. Antimicrobial peptides have not previously been studied for their impact on cold ischemia in transplanted kidneys. METHODS: Bactenecin (L- and D-forms) was added to University of Wisconsin (UW) preservation solution for 3-day cold storage of dog kidneys. Effects on membrane permeability were studied in synthetic liposomes and in kidney cortex tissue slices. The role of bactenecin as a tissue mitogen and direct cytoskeletal stabilizer were studied with cultured cells and in vitro. RESULTS: Bactenecin (both L- and D- forms) resulted in significant decreases in postoperative serum creatinine and time required for return of creatinine to the normal range showing the effect was independent of chirality. Bactenecin permeabilized synthetic liposomes and altered kidney cortex tissue slice membrane permeability characteristics, irrespective of chirality. Neither did bactenecin act as a mitogen for either primary renal tubule or Madin-Darby canine kidney (MDCK) cells stored in UW solution, nor did it appear to directly affect cytoskeletal dynamics. CONCLUSIONS: These results show that the antimicrobial peptide bactenecin can improve the quality of static cold storage of kidneys. The mechanism of its action is independent of receptor binding and does not appear to involve either an effect on the cytoskeleton or via activity as a mitogen. Current evidence best supports the hypothesis that bactenecin protects against cold ischemic injury by a controlled permeabilization of the membranes of the kidney during cold storage.     

Alterations of nitric oxide synthase expression and activity during rat lung transplantation

Decreased nitric oxide (NO) production has been reported during lung transplantation in patients. To study the effects of ischemia and reperfusion on endogenous NO synthase (NOS) expression, both an ex vivo and an in vivo lung injury model for transplantation were used. Donor rat lungs were flushed with cold low-potassium dextran solution and subjected to either cold (4 degrees C for 12 h) or warm (21 degrees C for 4 h) ischemic preservation followed by reperfusion with an ex vivo model. A significant increase in inducible NOS and a decrease in endothelial NOS mRNA was found after reperfusion. These results were confirmed in a rat single-lung transplant model after warm preservation. Interestingly, protein contents of both inducible NOS and endothelial NOS increased in the transplanted lung after 2 h of reperfusion. However, the total activity of NOS in the transplanted lungs remained at very low levels. We conclude that ischemic lung preservation and reperfusion result in altered NOS gene and protein expression with inhibited NOS activity, which may contribute to the injury of lung transplants.     

The role of coenzyme Q10 for preservation of the rat kidney: a model experiment for kidney transplantation.

In an experimental model system for kidney transplantation, the ability of the rat kidney to resynthesize ATP after warm ischemic time and subsequent restoration of renal blood flow was found to determine tissue viability and survival of the animal. The administration of CoQ₁₀ prior to warm ischemia enhanced the rate and extent of ATP resynthesis by reflow following two-hour warm ischemia and this was accompanied by an increase in survival rate of the rats.     

Effects of warm and cold ischemia on mitochondrial functions in brain,liver and kidney

The purpose of this work was to study the effects of warm (37°C) and cold (4°C) ischemia on different mitochondrial functions in rat brain, liver and kidney.After l0 to 60 minutes of ischemia at 37°C the energy coupled respiration as well as the ADP-induced malate-aspartate shuttle activity in brain and liver mitochondria or the rate of mitochondrial ATP synthesis in kidney were significantly decreased. However, the respiratory rates and the shuttle activity in the absence of ADP remained unchanged. These data suggest that ischemia primarily affects electron transport in the respiratory chain rather than the hydrogen shuttle and the energy coupling system. When the temperature during the indicated ischemic periods was decreased to 4°C, in brain and liver no significant alterations of these mitochondrial functions were found in comparison with the non-ischemic controls. When rat kidneys were stored for 36 hours at 4°C according to Collins mimicing transplantation conditions, the mitochondrial respiration and ATP synthesis were only slightly decreased. It therefore appears that hypothermia can prevent effectively mitochondrial dysfunction due to ischemia.     

Warm Ischemic Injury Is Reflected in the Release of Injury Markers during Cold Preservation of the Human Liver

Background

Liver transplantation plays a pivotal role in the treatment of patients with end-stage liver disease. Despite excellent outcomes, the field is strained by a severe shortage of viable liver grafts. To meet high demands, attempts are made to increase the use of suboptimal livers by both pretransplant recovery and assessment of donor livers. Here we aim to assess hepatic injury in the measurement of routine markers in the post-ischemic flush effluent of discarded human liver with a wide warm ischemic range.

Methods

Six human livers discarded for transplantation with variable warm and cold ischemia times were flushed at the end of preservation. The liver grafts were flushed with NaCl or Lactated Ringer’s, 2 L through the portal vein and 1 L through the hepatic artery. The vena caval effluent was sampled and analyzed for biochemical markers of injury; lactate dehydrogenase (LDH), alanine transaminase (ALT), and alkaline phosphatase (ALP). Liver tissue biopsies were analyzed for ATP content and histologically (H&E) examined.

Results

The duration of warm ischemia in the six livers correlated significantly to the concentration of LDH, ALT, and ALP in the effluent from the portal vein flush. No correlation was found with cold ischemia time. Tissue ATP content at the end of preservation correlated very strongly with the concentration of ALP in the arterial effluent (P<0.0007, R² = 0.96).

Conclusion

Biochemical injury markers released during the cold preservation period were reflective of the duration of warm ischemic injury sustained prior to release of the markers, as well as the hepatic energy status. As such, assessment of the flush effluent at the end of cold preservation may be a useful tool in evaluating suboptimal livers prior to transplantation, particularly in situations with undeterminable ischemic durations.     

Circannual cycles in golden-mantled ground squirrels: phase shift produced by low temperatures

Summary Golden-mantled ground squirrels,Spermophilus lateralis, were kept in a warm room (21 °C) until they had begun to lose weight following attaining a peak of body weight in the autumn. An experimental group was then transferred to a cold room (–3 °C) and kept there for about 9 months before being returned to the warm room. A control group was kept in the warm room throughout. The peaks in body weight of animals that had been exposed to the cold occurred 4.5 months later than those of the control animals. This difference was maintained when the animals were studied for a further year. Reproductive condition in the experimental animals, after they had been returned to the warm room, also occurred several months later than that in control animals. An extended sojourn in the cold therefore results in a phase shift in circannual cycles of this species.I thank Kirsteen Lang for much help and Linda Jones and others at the Environmental Sciences Centre, Kananaskis, for their cooperation. Janice Farintosh, Yasmin Shah and John Ting assisted with the experiments. The work was supported by the Natural Sciences and Engineering Research Council of Canada.     

Noninvasive monitoring of citrate, acetate, lactate, and renal medullary osmolyte excretion in urine as biomarkers of exposure to ischemic reperfusion injury

Injury during the transplant process affects the alloantigen-dependent factors and the alloantigen-independent processes of "chronic" rejection. Consequently, the determination of reliable parameters for the assessment of ischemic damage is essential for the prediction of renal changes after ischemia/reperfusion injury. The aim of this study was to assess the ability of (1)H NMR spectroscopy to predict the early graft dysfunction in an ischemia/reperfusion model after preservation in two standard preservation solutions, Euro-Collins (EC) and University of Wisconsin (UW). The second aim was to specify the role of the UW solution in preventing renal medullary injury. Urine and plasma samples from three experimental groups were examined during 2 weeks: control group (n = 5), EC group (cold flushed and 48-h cold storage of kidney in EC and autotransplantation, n = 12), and UW group (cold flushed and 48-h cold storage of kidney in UW and autotransplantation; n = 12). We also examined these kidneys 30-40 min after implantation and on the sacrifice day. Creatinine clearance was significantly reduced in the EC group during the second week. Fractional excretion of sodium and urine N-acetyl-beta-d-glucosaminidase activity were improved but not significantly different in the preserved groups. Urinary concentrations of the alpha-class glutathione S-transferase were significantly greater in the EC group during the first week after transplantation. The most relevant resonances for evaluating renal function after transplantation determined by (1)H NMR spectroscopy were those arising from citrate, dimethylamine (DMA), lactate, and acetate in urine and trimethylamine-N-oxide (TMAO) in urine and plasma. These findings suggest that graft dysfunction is associated with damage to the renal medulla determined by TMAO release in urine and plasma associated with DMA and acetate excretion. Citrate is also a urinary marker that can discriminate kidneys with a favorable evolution. Our results suggest that (1)H NMR spectroscopy is an efficient technique for detecting ischemic damage when accurate and precise data on graft injury is required. In addition, this study outlines the specific impact of the UW solution against injury to the renal medulla.     

The Effect of Dietary Protein on the Renal Gluconeogenic Capacity of Rats

Kidney cortex slices and homogenates of rats fed a high protein diet for 7 to 14 days had higher gluconeogenic capacity from fructose or oxaloacetate and fructose 6-phosphate or fructose 1, 6-diphosphate, respectively, than those of rats fed a high carbohydrate diet containing adequate protein. Levels of gluconeogenic enzymes, especially glucose 6-phosphatase and phosphoenolpyruvate carboxykinase, are good indicators of an increased capacity of renal gluconeogenesis of rats fed the high protein diet. Activities of renal glycolytic enzymes and glutamic-oxaloacetic and glutamic-pyruvic transaminases did not change and citrate concentrations of rat kidney decreased by feeding the high protein diet. Urinary excretion of ammonia of rats fed the high protein diet increased.     

The Efficacy of Antioxidants Administered during Low Temperature Storage of Warm Ischemic Kidney Tissue Slices

Accumulation of products of lipid peroxidation (malondialdehyde, conjugated dienes, lipid peroxides, and Schiff bases) was evaluated in rabbit kidney cortex slices made ischemic for 60 min followed by 18 h storage at 5°C in UW Na gluconate solution and 210 min normothermic reoxygenated incubation. In addition, the effect of adding Trolox (1 mM), deferoxamine (1 mM), and ascorbate (1 mM) as supplemental antioxidants to the UW gluconate solution was evaluated. Lipid peroxidation was slightly increased after hypothermic storage compared to slices subjected to ischemia alone but was not significantly different than ischemic slices during subsequent incubation at normothermia. The addition of either deferoxamine or Trolox to the storage solution substantially reduced lipid peroxidation both during hypothermic storage and subsequent to normothermic incubation. Ascorbate had a mild prooxidant effect as a sole additive to the UW gluconate solution but was clearly prooxidant when combined with either deferoxamine or Trolox. These results suggest that supplemental antioxidants added to the UW gluconate solution under conditions analogous to machine perfusion preservation have a potential role in reducing oxidative stress in kidney tissues harvested after warm ischemia and that hypothermia may be a valuable adjunct to resuscitative therapeutic regimens developed for salvage of ischemic kidneys for transplantation.     

Bile analysis as a tool for assessing integrity of biliary epithelial cells after cold ischemia--reperfusion of rat livers

Previous morphological studies failed to show appreciable injury of biliary epithelial cells (BEC) after cold ischemia of rat liver, although recent evidence indicated that BEC integrity and function were impaired in this model. We tested the hypothesis that analysis of bile for enzymes, such as lactate dehydrogenase (LDH), alanine transaminase (ALT), and aspartate transaminase (AST), can be used for assessing cold ischemic injury of BEC. Furthermore, we examined whether biliary gamma-glutamyltransferase (GGT) reflects warm ischemic injury of BEC and whether normothermic reperfusion aggravates the negative effect of cold ischemia on BEC integrity and function. Rat livers were reperfused after different periods of cold or warm ischemia using a blood-free perfusion model. Compared with controls, perfusate LDH, ALT, and AST levels and parameters of hepatocyte function, including hepatocyte tight junction permeability, were not significantly altered by 18-h cold ischemia. On the other hand, 9-h cold ischemia markedly increased biliary LDH, ALT, and AST levels. However, only LDH release into the bile was strongly dependent on the time of cold storage. Biliary GGT, LDH, and glucose levels decreased during the reperfusion period following 18-h cold ischemia. The results suggest that biliary LDH can be used for assessing injury of BEC in cold-preserved livers and that normothermic reperfusion does not aggravate preservation-induced injury of BEC after cold ischemic storage.     

Change of the Gluconeogenic Capacity of Rat Kidney Cortex Slices with Dietary Components

Substituting protein for carbohydrate in diets significantly enhanced the rates of glucose formation from pyruvate, glutamate, or glycerol in rat kidney cortex slices. The tissue, however, increased slightly its gluconeogenic capacity in response to low carbohydrate, high fat diet. The rates of glucose taken up per unit weight of kidney cortex of rats fed a high carbohydrate diet was higher than those of rats fed diets high in protein or fat. Kidney weight in g per 100 g body weight (relative kidney size) of rats fed diets high in protein was significantly higher than that of rats fed diets high in carbohydrate or fat.     

The effect of quinacrine on oxidative stress in kidney tissue stored at low temperature after warm ischemic injury

Rabbit kidney cortex tissue slices were made ischemic (37 degrees C) for 60 min and then either reperfused in warm (37 degrees C) oxygenated physiologic buffer for 210 min or placed in UW Na gluconate solution (+/- quinacrine; 100 micromol/L) for 18 h followed by warm aerobic reperfusion. Slices were sampled at intervals and analyzed for malondialdehyde (MDA) content by HPLC. Control (nonischemic) slices had no change in MDA content over the duration of the experiment. Hypothermic storage of nonischemic slices did not result in any increase in MDA during reperfusion. Ischemic slices showed significant increases in MDA content during the first 1.5 h of reperfusion and remained elevated for the remainder of the experiment. Hypothermic storage of warm ischemic kidney slices resulted in a significant decrease in MDA content during the storage period. However, MDA content in these slices increased during warm reperfusion and was significantly higher than that in nonischemic controls. Quinacrine added during hypothermic storage of warm ischemic slices significantly decreased slice MDA content during warm reperfusion, an effect which was lost by increasing the storage solution calcium content. This study shows that aerobic hypothermic storage can aid in reducing oxidative stress in warm ischemic kidney tissue during reperfusion. This study suggests that the effects of quinacrine are at the level of the mitochondrion and not as an antioxidant compound.     

Oxygenated machine perfusion mitigates surface antigen expression and improves preservation of predamaged donor livers

The aim of the present study was to evaluate the potential benefit of machine preservation with the Belzer MPS or HTK solution, compared to standard cold storage, after procurement of marginal livers from non-heart beating donors in an experimental pilot study. Livers from male Wistar rats (250-300 g bw) were harvested after 60 min of cardiac arrest, flushed via the portal vein and cold stored submerged in HTK for 24 h at 4 degrees C while other organs were subjected to oxygenated machine perfusion with HTK or Belzer's MPS at 5 ml/min at 4 degrees C. Cold perfusion of livers with the non-colloidal HTK was not compromised by the lack of oncotic agents and there was no rise in vascular resistance during the 24 h of machine preservation with HTK or the colloidal Belzer MPS. Viability of the livers was assessed after the cold preservation period by warm reperfusion in vitro. Oxygenated machine perfusion was found to significantly increase viability of the livers vs simple cold storage with respect to portal vascular resistance upon reperfusion, enzyme release as well as functional recovery of oxygen utilization or bile production. Moreover, tissue antigen expression of ICAM-1 or histocompatibility antigen class II could be markedly reduced by oxygenated perfusion preservation as compared to cold storage. It is concluded that predamaged organs should preferably be preserved by oxygenated machine perfusion thus minimizing functional alterations and immunogenicity of the graft. In this setup HTK appeared equally effective as Belzer's MPS for machine preservation.     

Synchronization of circannual cycles: a cold spring delays the cycles of thirteen-lined ground squirrels

Summary Ground squirrels, show circannual cycles with periods normally less than a year when kept under laboratory conditions. The way in which environmental factors synchronize these cycles with the geophysical year under natural conditions is not known. We tested the possibility that cold temperatures can cause long-term phase delays in circannual cycles of thirteen-lined ground squirrels.Two groups of animals were kept in the cold (4 °C) for either 8.5 or 13 months, after which they were returned to the warm (21 °C) and kept there until they had completed at least one additional cycle. A third group was kept in the warm for the entire experiment. Most of the males in the cold room groups became arrested in the spring phase of their cycles while they were in cold. When returned to the warm, these males resumed cycling. When animals showed prolonged spring phases, their cycles were phase-delayed and continued to reflect this delay even after they were returned to the warm. Both body weight cycles and molt cycles were delayed. In contrast to the males in the cold room, none of the females in the cold room groups and none of the warm room animals of either sex showed this response.Our results demonstrate that cold temperatures can phase-delay both body weight and molt cycles and that the spring phase is a critical stage in this effect. We suggest that spring temperatures are largely responsible for the seasonal synchronization of circannual cycles in ground squirrels and are, therefore, a possible Zeitgeber for these cycles.