Red blood cells as oxygen carrier during normothermic machine perfusion of kidney grafts: Friend or foe?
Asel S. Arykbaeva, Lente J. S. Lerink, J. Vos, Marten A. Engelse, Cees van Kooten, Dirk de Korte, Johan W.M. Lagerberg, Thomas R. Klei, Aat A. Mulder, Robert C. Minnee, Rutger J. Ploeg, Jesper Kers, Cyril Moers, Robert A. Pol, Ian P.J. Alwayn, Dorottya K. de Vries, J. Lindeman
Abstract
Renal ex-vivo normothermic machine perfusion (NMP) is under development as an assessment tool for high-risk kidney grafts, and as a means of achieving more physiologically accurate organ preservation. On-going hemolysis has been reported during NMP, as this technique relies on red blood cells (RBCs) for oxygen delivery. In this study we confirm the occurrence of progressive hemolysis during 6-hour kidney NMP. NMP-associated erythrostasis in the glomeruli and in peri-glomerular vascular networks point to an interaction between the RBCs and the graft. Continuous hemolysis resulted in pro-oxidative changes in the perfusate, which could be quenched by addition of fresh frozen plasma. In a cell based system, this hemolysis induced redox stress and exhibited toxic effects at high concentrations. These findings highlight the need for a more refined oxygen carrier in the context of renal NMP. Renal ex-vivo normothermic machine perfusion (NMP) is under development as an assessment tool for high-risk kidney grafts, and as a means of achieving more physiologically accurate organ preservation. On-going hemolysis has been reported during NMP, as this technique relies on red blood cells (RBCs) for oxygen delivery. In this study we confirm the occurrence of progressive hemolysis during 6-hour kidney NMP. NMP-associated erythrostasis in the glomeruli and in peri-glomerular vascular networks point to an interaction between the RBCs and the graft. Continuous hemolysis resulted in pro-oxidative changes in the perfusate, which could be quenched by addition of fresh frozen plasma. In a cell based system, this hemolysis induced redox stress and exhibited toxic effects at high concentrations. These findings highlight the need for a more refined oxygen carrier in the context of renal NMP.