TY - JOUR
T1 - Metabolic needs of the kidney graft undergoing normothermic machine perfusion
AU - Arykbaeva, Asel S.
AU - de Vries, Dorottya K.
AU - Doppenberg, Jason B.
AU - Engelse, Marten A.
AU - Hankemeier, Thomas
AU - Harms, Amy C.
AU - Wijermars, Leonie G.
AU - Schaapherder, Alexander F.
AU - Bakker, Jaap A.
AU - Ploeg, Rutger J.
AU - Alwayn, Ian P. J.
AU - Lindeman, Jan H. N.
N1 - Funding Information: The authors are grateful to the anonymous reviewer for introducing the 4R concept. Publisher Copyright: © 2021 International Society of Nephrology Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/8
Y1 - 2021/8
N2 - Normothermic machine perfusion (NMP) is emerging as a novel preservation strategy. During NMP, the organ is maintained in a metabolically active state that may not only provide superior organ preservation, but that also facilitates viability testing before transplantation, and ex situ resuscitation of marginal kidney grafts. Although the prevailing perfusion protocols for renal NMP are refined from initial pioneering studies concerning short periods of NMP, it could be argued that these protocols are not optimally tailored to address the putatively compromised metabolic plasticity of marginal donor grafts (i.e., in the context of viability testing and/or preservation), or to meet the metabolic prerequisites associated with prolonged perfusions and the required anabolic state in the context of organ regeneration. Herein, we provide a theoretical framework for the metabolic requirements for renal NMP. Aspects are discussed along the lines of carbohydrates, fatty acids, amino acids, and micronutrients required for optimal NMP of an isolated kidney. In addition, considerations for monitoring aspects of metabolic status during NMP are discussed.
AB - Normothermic machine perfusion (NMP) is emerging as a novel preservation strategy. During NMP, the organ is maintained in a metabolically active state that may not only provide superior organ preservation, but that also facilitates viability testing before transplantation, and ex situ resuscitation of marginal kidney grafts. Although the prevailing perfusion protocols for renal NMP are refined from initial pioneering studies concerning short periods of NMP, it could be argued that these protocols are not optimally tailored to address the putatively compromised metabolic plasticity of marginal donor grafts (i.e., in the context of viability testing and/or preservation), or to meet the metabolic prerequisites associated with prolonged perfusions and the required anabolic state in the context of organ regeneration. Herein, we provide a theoretical framework for the metabolic requirements for renal NMP. Aspects are discussed along the lines of carbohydrates, fatty acids, amino acids, and micronutrients required for optimal NMP of an isolated kidney. In addition, considerations for monitoring aspects of metabolic status during NMP are discussed.
KW - kidney transplantation
KW - machine perfusion
KW - metabolism
KW - normothermic
KW - organ preservation
UR - http://www.scopus.com/inward/record.url?scp=85106355638&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.kint.2021.04.001
DO - https://doi.org/10.1016/j.kint.2021.04.001
M3 - Review article
C2 - 33857572
SN - 0085-2538
VL - 100
SP - 301
EP - 310
JO - Kidney International
JF - Kidney International
IS - 2
ER -