The assessment of renal preservation by normothermic bloodless perfusion.

A method of estimating renal function by normothermic perfusion in vitro has been developed. In this paper, its application to the study of different methods of hypothermic renal preservation in the rabbit is described. Groups of kidneys were stored at 4 °C for 24 hr by surface cooling alone, by initial perfusion followed by storage (washout perfusion), and by continuous perfusion. Renal function was found to be severely compromised after surface cooling alone or after washout perfusion with an isotonic solution resembling extracellular fluid. Washout with a solution containing sufficient additional glucose to raise the osmolality to 400 mosm/kg gave greatly improved function, but increasing the concentration of magnesium from 2 to 72 mequiv/litre failed to confer any additional benefit, and increasing the concentration of potassium from 4 to 74 mequiv/ litre depressed function. Continuous perfusion with a solution containing albumin and dextran gave results that were inferior to the best washout method, but increasing the osmolality of the perfusate with glucose again resulted in a very significant improvement in function, which however was still inferior to the best washout method of storage. The further use of this test system to study methods of renal preservation is advocated.     

Function of rabbit kidneys in vitro at normothermia following equilibration with 3.0 M Me2SO and removal by hypertonic washout at 10 degrees C

In the present study, rabbit kidneys were assayed for function on a 37 °C in vitro perfusion system after perfusion on a 10 °C perfusion system which permits the slow introduction and removal of cryoprotectant. The final concentration of 3.0 M Me₂SO was introduced slowly at two different rates. The washout was achieved by perfusion with Me₂SO-free solutions made hypertonic with mannitol. Two regimens of washout were used: 800, 700, 600, 500, and 400 mOsm/kg; and 600, 500, and 400 mOsm/kg.During perfusion at 37 °C, the glomerular filtration rate was similar in all groups and this increased significantly in all groups with time. Protein leakage was minimal. All three Me₂SO groups showed a depressed Na reabsorption capacity, but the 800 mOsm group was the most severely affected. This was also found with glucose reabsorption. We concluded that rabbit kidneys will function well with the cryoprotectant Me₂SO up to 3 M concentration when introduced slowly and washed out with hypertonic mannitol beginning at 600 mOsm/kg. When 800 mOsm is used at the initial step, the proximal tubular function is severely affected.     

Introduction and removal of cryoprotective agents with rabbit kidneys: assessment by transplantation

Rabbit kidneys were perfused with up to 4 M glycerol or propane-1,2-diol (propylene glycol, PG) in three vehicle solutions: one normokalemic and made hypertonic with mannitol (HP5), one hyperkalemic but without mannitol (HP6), and one hyperkalemic and with mannitol (HP7). Subsequent function was assessed by autotransplantation. Up to 3 M glycerol in HP5 was well tolerated but not in HP6 or HP7. Conversely, up to 3 M PG in HP7 was compatible with excellent post-transplant function, but the same concentration in HP5 was severely damaging. PG (4 M) in either solution was severely injurious and no kidneys survived perfusion with this concentration. Vascular resistance was well controlled by the vehicle solutions with mannitol, but it was generally higher during perfusion with the hyperkalemic HP7 compared with the normokalemic HP5. No kidneys perfused with 3 M solutions of either of the cryoprotective agents and cooled briefly to -6 degrees C without freezing had any post-transplant function, and neither did kidneys perfused with 3 M PG or 4 M glycerol tolerate slow cooling to -80 degrees C and warming. The need to optimize perfusate composition for the CPA being used is clear, and the dramatic increase in toxicity of PG when the concentration exceeds 3 M supports the suggestion that mixtures of PG and glycerol should be considered. The observation of damage at high subzero temperatures, before freezing has occurred, requires further detailed study.     

Cold and hyperosmolar fluids in canine trachea: vascular and smooth muscle tone and albumin flux

We have studied the effects of liquids of various osmolalities and temperatures on the tracheal vasculature, smooth muscle tone, and transepithelial albumin flux. In 10 anesthetized dogs a 10- to 13-cm length of cervical trachea was cannulated to allow instillation of fluids into its lumen. The cranial tracheal arteries were perfused at constant flow, with monitoring of the perfusion pressures (Ptr) and the external tracheal diameter (Dtr). Control fluid was Krebs-Henseleit solution (KH) with NaCl added to result in a 325-mosM solution (isotonic). Hypertonic solutions were KH with NaCl (warm hypertonic) or glucose (hypertonic glucose) added to result in a 800-mosM solution. All solutions were at 38 degrees C, with isotonic and the hypertonic NaCl solutions also given at 18 degrees C (cold isotonic and cold hypertonic). Fluorescent labeled albumin was given intravenously, and the change in fluorescence in the fluid was measured during each 15-min period. Changing from warm isotonic to cold isotonic decreased Dtr and Ptr. Changing from warm isotonic to warm hypertonic or hypertonic glucose decreased Ptr with no change in Dtr. The cold hypertonic responses were not different from cold isotonic responses. Warm hypertonic solution increased albumin flux into the tracheal lumen over a 15-min period to three times that of the control period, persisting for 15 min after replacement with warm isotonic solution. Cooling induces a vasodilation and smooth muscle contraction of the trachea, whereas hypertonic solutions result in vasodilation and, if osmolality is increased with NaCl, an increase in albumin flux into the tracheal lumen.     

Optimization of a vehicle solution for the introduction and removal of glycerol with rabbit kidneys

Previous studies with rabbit kidneys in our laboratories have used a plasma-like solution as the vehicle for the introduction and removal of glycerol. Other workers have usually employed high-potassium solutions. In this study we have assayed the function of rabbit renal cortical slices after incubation in a range of solutions, each of which contained 1 M glycerol, for 4 hr, followed by stepwise removal of the cryoprotectant. The functions measured were endogenous oxygen consumption, p-aminohippurate uptake, and the ability of the slices to accumulate potassium. Exposure to glycerol produced a considerable reduction of slice function, but, in the presence of glycerol, elevation of the potassium concentration was beneficial, whereas high concentrations of magnesium were detrimental. The optimum potassium concentration was 70-100 mM. Replacement of chloride by a range of anions of higher molecular weight was either without benefit (glycerophosphate) or detrimental (sulfate, citrate, and gluconate). Elevation of total osmolality from 300 to 400 mosmolal with glucose, mannitol, glycerophosphate, or Pipes reduced slice function, but when the same osmolality was achieved by raising the concentration of all the components of the solution in the same ratio, there was no significant loss of function. There was a weak optimum pH at ca. 7.0. These experiments led to the formulation of a bicarbonate-buffered perfusate containing 80 mM potassium and 17.5 g Haemaccel per liter, having a pH of 7.0 with 5% CO2 at 10 degrees C, and an osmolality of 400 mosmol/kg. This solution was used to preserve rabbit kidneys for 20 hr at 10 degrees C, by continuous perfusion, and was compared with our previous Haemaccel perfusate, HP5, which contained 4 mM K+, 111 mM mannitol, and had a pH of 7.4. The two solutions were equally effective.     

Reduction of experimental myocardial infarct size with hyperosmolar mannitol.

Hypertonic mannitol previously has been shown to improve cardiac function, increase collateral flow, and decrease epicardial ST segment elevation following coronary occlusion in anesthetized or awake dogs. The present study quantitates by morphologic techniques, the effect of hypertonic mannitol on infarct size. Ischemic injury was produced by proximal occlusion of the circumflex artery for 40 min and necrosis was assessed after 48 hr of reflow. One group of dogs was given isotonic saline and the other hypertonic mannitol beginning the infusions just prior to, during, and for a short period after the release of the circumflex coronary artery occlusion. Serum osmolality increased by approximately 40 mOsm in the mannitol group. The administration of hypertonic mannitol was associated with a 40-50% reduction in infarct size ventricular fibrillation during occlusion and following release of the circumflex coronary artery occlusion was greater in mannitol-treated dogs although the difference was not statistically significant. Thus, the data obtained in this study extend previous observations and provide direct evidence that hypertonic mannitol can reduce infarct size in dogs with temporary circumflex artery occlusion and reflow.     

Rabbit kidney function in vitro: the effect of colloids, energy substrate, a vasodilator, perfusion pressure, and bovine serum albumin

An in vitro perfusion system at 37 degrees C for the assessment of rabbit kidney function is described. The purpose of this assay system is to evaluate the effects of cryobiological manipulation on kidney function. The effect of the colloids dextran (MW = 70,000, 80,000, and 180,000) in the perfusate at 110 mm Hg were compared to a reduced perfusion pressure, colloid-free perfusate. Better function was obtained at lower perfusion pressure with the colloid-free perfusate. Less damage was noted histologically on light and electron microscopy. Investigation of energy substrates on rabbit kidney function demonstrated that butyrate, or lactate, in addition to glucose resulted in increased sodium and glucose reabsorption over glucose alone. Substrate-free perfused kidneys exhibited depressed Na transport. Lactate, and to some extent butyrate, decreased net glucose utilization. An alpha-adrenergic blocking agent, isoxsuprine, in the initial flush solution did not appear to be beneficial. An increase of perfusion pressure from 50 to 75 mm Hg resulted in an increase in GFR. Tubular function was enhanced by inclusion of small amounts of BSA in the perfusate.     

Pulmonary epithelial sieving of small solutes in rat lungs

Transport and consumption of glucose from the air spaces of isolated, fluid-filled lungs can result in significantly lower glucose concentrations in the air spaces than in the perfusate compartment (11). This concentration difference could promote the osmotic movement of water from the air spaces to the perfusate, but the rate of fluid extraction from the air spaces would then be limited by the rates of electrolyte transport through the epithelium. In the present study, measurements were made of solute and water losses from the air spaces of fluid-filled rat lungs and the transport of these solutes and water into the vasculature after addition of hypertonic glucose or sucrose to the perfusate. Increases in the concentrations of Na+, Cl-, K+, and labeled mannitol in the air space were initially comparable to those of albumin labeled with Evans blue. Similarly, decreases in electrolyte concentrations in the perfusate were comparable to those of labeled albumin, indicating that very little solute accompanied the movement of water out of the lungs. Nor was evidence found that exposure of the vasculature to hypertonic glucose resulted in an increase in the rate at which fluid was reabsorbed from the air spaces over a 1-h interval, aside from an initial, abrupt loss of solute-free water from the lungs. These observations suggest that perfusion of fluid-filled lungs with hypertonic solutions of small solutes results in the extraction of water from the air spaces and pulmonary parenchyma across membranes that resist the movement of electrolytes and other lipophobic solutes.     

Perfusion rate dependent prostaglandin release from isolated rabbit kidneys

Isolated rabbit kidneys were perfused with 37 degrees C Krebs-Henseleit solution aerated with 95% O2 + 5% CO2. Perfusion rate was varied from 1 to 10 ml/min. This was accompanied by parallel changes of perfusion pressure, prostaglandin excretion and release of radioactivity from kidneys with 14C-arachidonic acid incorporated into the tissue lipid pool. It is suggested that enhancement of perfusion rate raises the intrarenal pressure which increases renal prostaglandin release due to increased substrate availability.     

The membrane attack complex in complement-mediated glomerular epithelial cell injury: formation and stability of C5b-9 and C5b-7 in rat membranous nephropathy

Using a model of rat membranous nephropathy (MN), we examined the relationship between the development of glomerular epithelial cell injury and the formation and stability of the membrane attack complex (MAC) of complement. Isolated rat kidneys were perfused with buffered bovine albumin (BSA) or various plasmas (complement source). Kidneys containing nephritogenic amounts of complement-fixing sheep antibody to glomerular epithelial antigens (aFx1A) perfused with BSA (n = 5), and normal kidneys perfused with normal human plasma in BSA (50% v/v, n = 6) excreted 0.30 +/- 0.02 mg protein/min/g during 90 min perfusion (control groups). When normal plasma was added to the perfusate of aFx1A kidneys at concentrations of 12.5, 25, and 50% v/v, protein excretion rose in a time- and concentration-dependent manner. Perfusions with 25% plasma resulted in baseline proteinuria from 0 to 20 min that increased to 2.8 +/- 0.9 mg/min/g at 20 to 40 min and 8.6 +/- 2.1 at 40 to 60 min (n = 4, p less than 0.01 vs control groups). Removal of plasma at 20 min did not prevent this rise in protein excretion (3.9 +/- 2.4 and 5.8 +/- 2.6 mg/min/g at 30 to 40 and 55 to 65 min respectively, p less than 0.01, n = 4). Perfusion of aFx1A kidneys with C8-deficient (C8D) human plasma (25% v/v, n = 4) or C6D rabbit serum (25% v/v, n = 2) independently produced low levels of proteinuria comparable with BSA, but in combination, the two reagents restored enhanced protein excretion (n = 2). In aFx1A kidneys containing C5b-7, addition of C8 and C9 (C6D serum) after intervals of 20, 60, or 90 min immediately reconstituted heavy proteinuria. Thus, the magnitude of MAC-induced glomerular epithelial injury in rat MN is related to the complement dose. Altered glomerular permeability is delayed with respect to the onset of complement activation. Once sufficient C5b-9 is formed, proteinuria can develop despite cessation of new MAC assembly, implying that C5b-9 persists after formation. Moreover, the C5b-7 MAC intermediate is not eliminated rapidly in this model.     

Effects of differences in substrate supply on the energy metabolism of hypothermically perfused canine kidneys

Experiments were performed on the effects of differences in substrate supply on canine kidneys. Following 2 min of ischemia and flush perfusion for 5 min the kidneys were continuously perfused at 6 °C using albumin perfusate containing free fatty acids and glucose or Haemaccel perfusate without substrates.During 120 hr of perfusion neither potassium nor LDH nor GOT accumulation differed between the two perfusates and up to the 48th hr the tissue contents of adenine nucleotides as well as the energy charge potential were almost identical. The results show that in canine kidneys glucose or FFA supply during hypothermic continuous perfusion does not influence the overall cellular integrity and energetic capacity of the renal cortex at least up to the 48th hr of preservations.     

Assessment of hepatic integrity after ischemic preservation by isolated perfusion in vitro: the role of albumin

Isolated perfusion of rat livers (IPRL) represents an attractive set-up to be used as a an evaluative tool in the easy and reproducible assessment of liver injury, allowing for screening of new approaches to organ preservation without the expenditure of actual transplantation experiments. Depending on the pathology under investigation, controversy exists concerning the inclusion of albumin in the IPRL. The present study evaluates the use of bovine serum albumin (BSA), simultaneously comparing its effect on healthy and ischemically challenged livers in the same model. Rat livers were excised, flushed via portal vein with Histidine-Tryptophan-Ketoglutarate (HTK) solution and preserved for up to 18 h in HTK at 4 degrees C. Perfusion was performed with Krebs-Henseleit buffer with or without addition of 3% BSA. Control preparations were perfused without prior ischemic storage. In the described model, stability of the preparations was documented for up to 120 min of isolated perfusion and addition of 3% BSA had no adverse effects on the viability of nonischemic livers. While liver perfusion without albumin was inappropriate to reveal alterations in parenchymal or vascular integrity after 18 h of cold preservation, albumin in the perfusate significantly and gradually unmasked differences between nonischemic liver preparations and livers stored ischemically for 8 or 18 h. It could be shown that BSA did have a significant modulatory effect on hepatic induction of apoptosis after ischemia in reducing cleavage of caspase 3. The implementation of albumin is advocated since experimental results are pivotally influenced by the presence or absence of this physiologically constitutive compound in the perfusate.     

The isolated perfused rabbit ovary — A model for studies of ovarian function

Summary In the present investigation the ultrastructure of isolated rabbit ovaries, perfused with different media for various time periods, was studied. The steroid hormone production by the perfused ovary was also determined. Perfusion with Medium 199 results in prominent interstitial ovarian oedema which increases with perfusion time. Even after the addition of 6–10 % Dextran T40, oedema appears in the interstitial tissue of the ovary. Perfusion solutions with osmotically active colloid particles of large molecular size (Dextran T70; average molecular weight 70,000 and bovine serum albumin), cause less distortion in the ovarian structure, and ultrastructurally the ovarian tissues appear essentially the same as in the control ovaries.The results indicate that the perfused rabbit ovary, under strictly controlled conditions, can be used as an experimental model for studies of various aspects of ovarian function, including follicular rupture.     

Distribution and removal of glycerol by vascular albumin perfusion in rabbit kidneys.

A simple perfusion circuit for gradual glycerolization and deglycerolization of rabbit kidneys is described; it has been used to study vascular resistance and glycerol distribution during perfusion at +10 °C with a perfusate of extracellular composition.An attempt was made to diminish the dramatic rise in vascular resistance during deglycerolization of rabbit kidneys, seen in previous experiments, by increasing the perfusate colloid osmotic pressure and decreasing the rate of change of cryoprotectant concentration during the last third of removal. These modifications of the method did not improve perfusion characteristics or post-transplant function.Melting points of perfusates and different parts of the kidney were determined by differential thermal analysis before glycerolization, after glycerolization to 3 m and after subsequent deglycerolization. The variations of tissue melting temperatures were found to be identical with variations in the perfusate, thus indicating a complete distribution and removal of cryoprotective concentrations of glycerol.     

Perfusion rate dependent prostaglandin release from isolated rabbit kidneys

Isolated rabbit kidneys were perfused with 37°C Krebs-Henseleit solution aerated with 95% O₂ + 5% CO₂. Perfusion rate was varied from 1 to 10 ml/min. This was accompanied by parallel changes of perfusion pressure, prostaglandin excretion and release of radioactivity from kidneys with ¹⁴C-arachidonic acid incorporated into the tissue lipid pool. It is suggested that enhancement of perfusion rate raises the intrarenal pressure which increases renal prostaglandin release due to increased substrate availability.     

Beneficial effect of low concentrations of cryoprotective agents on short-term rabbit kidney perfusion

This report describes observations concerning the influence of the addition of 0.3 M cryoprotective agents (propylene glycol or glycerol) to Ringer's albumin solution used for rabbit kidney perfusion for periods of less than 4 and 24 hr. Endogenous creatinine clearance during short-term parabiotic perfusion on a shunt was used to evaluate function after perfusion. The findings were (A) Perfusion for less than 4 hr resulted in a significant loss of function by comparison with 1 hr ice-stored controls. (B) Continuing the perfusion for 24 hr resulted in a further significant fall in function. Much of the early perfusional injury seen in these two groups could be avoided by including 0.3 M cryoprotective agents in the perfusate.     

Plasma hyperosmolality stimulates leptin secretion acutely by a vasopressin-adrenal mechanism

Glucose administration to rodents acutely stimulates leptin secretion. To investigate the mechanism, rats were infused intravenously with various concentrations of glucose, and plasma leptin concentrations were measured with time. The osmolality of the infusates was equalized with various concentrations of carbohydrates that are not metabolized. Hyperosmolar glucose stimulates leptin secretion in a dose-dependent manner, with peak plasma leptin concentrations occurring approximately 3 h after the end of the glucose infusion. Hypertonic infusions of galactose, mannitol, and sodium chloride independently stimulate leptin secretion with approximately one-half the strength of equivalent osmolar concentrations of glucose. Peak plasma leptin concentrations occur approximately 4 h after the end of the hypertonic solution infusion. Hypertonic solutions of mannitol do not stimulate leptin secretion in vasopressin-deficient or in adrenalectomized animals. In conclusion, intravenous infusions of hypertonic glucose and hypertonic mannitol independently stimulate leptin secretion. Hyperosmolality stimulates leptin secretion by a vasopressin-adrenal mechanism.     

Advanced glycation end products upregulate angiogenic and pro-inflammatory cytokine production in human monocyte/macrophages

Glucose can react non-enzymatically with amino groups of, for example, proteins, to yield derivatives termed advanced glycation end products (AGE), which contribute to many chronic progressive diseases associated with microvascular complications. The study aimed to determine the effect of AGE-modified albumin on THP-1 cells and human monocyte-derived macrophages. Bovine serum albumin (BSA) or human serum albumin (HSA), modified by glucose-derived AGE, was prepared by incubation with glucose for differing periods of time. Alternatively, BSA was incubated with sodium cyanoborohydride and glyoxylic acid to produce N(epsilon)-(carboxymethyl)lysine-modified BSA (CML-BSA). Stimulation for 24h of THP-1 cells with BSA, incubated for 6-8 weeks with glucose, induced significant VEGF release. Human monocyte-derived macrophages stimulated with extensively glycated HSA also showed significant VEGF release, as well as upregulation of IL-8 production, incubation for 6h with extensively glycated HSA increased release of TNFalpha and expression of tissue factor. Finally, addition of CML-BSA resulted in significant induction of TNFalpha and VEGF release. We demonstrate that a range of different methods of glycation of BSA and HSA, including CML-BSA, resulted in the induction of VEGF, TNFalpha, IL-8 and expression of tissue factor, according to length of stimulation and different glycation products used, suggesting that AGE-induced activation of macrophages may contribute to vascular complications by regulation of angiogenic, inflammatory and pro-coagulant processes.     

Renal preservation by hypothermic perfusion. I. The importance of pressure-control

Rabbit kidneys were preserved by hypothermic perfusion at 5 °C using a perfusate containing an extracellular balance of ions, dextran and bovine serum albumin. Two groups were studied: in one, the pressure was kept constant at 40 mm Hg, while in the other the flow was maintained at 13 ml/min. The mean flows in the two groups were similar but the resistance of the kidneys perfused under constant-flow conditions was lower and more stable: the vascular resistance in the constant-pressure group showed considerable fluctuations throughout the 24 hr perfusion period. The function of the kidneys was assessed by autotransplantation with immediate contralateral nephrectomy. The constant-pressure group functioned better in all respects: the proportion of animals surviving was higher, the postoperative blood urea and creatinine levels were lower, and histological examination of the kidneys revealed less damage. It is concluded that constantpressure perfusion should be preferred to constant-flow perfusion. These experiments confirmed that there is a correlation between potassium release into the perfusate and subsequent function, and an unexpected inverse correlation was observed between the perfusate glucose level and subsequent function. Possible reasons for this are discussed.     

Vascular perfusability and capillary macromolecular permeability in the mechanically induced rabbit hydrosalpinx

The mechanically induced rabbit hydrosalpinx, a frequently studied animal model of human hydrosalpinges, was examined to determine the variations, in vascular perfusion and capillary albumin permeability, which occur in hydrosalpinges. At laparotomy, 4 adult female virgin rabbits underwent isthmic and ampullary occlusion with small tantalum clips. 4 weeks later, fluorescein isothiocyanate-labelled bovine serum albumin (FITC BSA: molecular weight 67,000) was injected intravenously 5 min before oviduct excision. Examination of tubal sections by incident light fluorescent microscopy demonstrated poor interplical vascular perfusability and markedly reduced interplical capillary permeability to FITC BSA in both isthmic and ampullary segments of hydrosalpinx. These observations imply that, in the experimental rabbit hydrosalpinx, interplical deciliation is probably vascular in origin; furthermore the marked decrease in capillary macromolecule permeability may explain the serous fluid collection within the hydrosalpinx. Poor fecundity following microsurgical restoration of tubal patency in hydrosalpinges is possibly due to the failure of this decrease in submucosal capillary perfusability and macromolecular permeability to resolve.