Subnormothermic Perfusion with H2S Donor AP39 Improves DCD Porcine Renal Graft Outcomes in an Ex Vivo Model of Kidney Preservation and Reperfusion

• Published in: Biomolecules (Basel, Switzerland) Vol. 11; no. 3; p. 446
• Main Authors: Juriasingani, Smriti, Ruthirakanthan, Aushanth, Richard-Mohamed, Mahms, Akbari, Masoud, Aquil, Shahid, Patel, Sanjay, Al-Ogaili, Rafid, Whiteman, Matthew, Luke, Patrick, Sener, Alp
• Format: Journal Article
• Language: English
• Published: Basel MDPI AG 17.03.2021; MDPI
• Subjects: AP39; Apoptosis; Autografts; Blood; Cold; Cold storage; Cryopreservation; donation after cardiac death; Experiments; Gene expression; Hydrogen sulfide; Hypoxia; Ischemia; ischemia–reperfusion injury; kidney preservation; Kidney transplantation; Kidneys; Perfusion; Renal function; Reperfusion; subnormothermic perfusion; Transplants & implants; United States > US
• ISSN: 2218-273X; 2218-273X
• DOI: 10.3390/biom11030446

Cold preservation is the standard of care for renal grafts. However, research on alternatives like perfusion at higher temperatures and supplementing preservation solutions with hydrogen sulfide (H2S) has gained momentum. In this study, we investigated whether adding H2S donor AP39 to porcine blood during subnormothermic perfusion at 21 °C improves renal graft outcomes. Porcine kidneys were nephrectomized after 30 min of clamping the renal pedicles and treated to 4 h of static cold storage (SCS) on ice or ex vivo subnormothermic perfusion at 21 °C with autologous blood alone (SNT) or with AP39 (SNTAP). All kidneys were reperfused ex vivo with autologous blood at 37 °C for 4 h. Urine output, histopathology and RNAseq were used to evaluate the renal graft function, injury and gene expression profiles, respectively. The SNTAP group exhibited significantly higher urine output than other groups during preservation and reperfusion, along with significantly lower apoptotic injury compared to the SCS group. The SNTAP group also exhibited differential pro-survival gene expression patterns compared to the SCS (downregulation of pro-apoptotic genes) and SNT (downregulation of hypoxia response genes) groups. Subnormothermic perfusion at 21 °C with H2S-supplemented blood improves renal graft outcomes. Further research is needed to facilitate the clinical translation of this approach.