Perfusion of Porcine Kidneys with Macromolecular Heparin Reduces Early Ischemia Reperfusion Injury

Background Previously we have been able to demonstrate the possibility of coating the inner surface of the renal arteries in porcine kidneys with a heparin conjugate during hypothermic machine perfusion (HMP). The purpose of this study was to assess the efficacy of this treatment in reducing early ischemia-reperfusion injury. Method Brain death was induced in male landrace pigs by stepwise volume expansion of an epidural balloon catheter until negative cerebral perfusion pressure was obtained. Both kidneys (matched pairs; n=6+6) were preserved for 20 hours by HMP during which 50 mg heparin conjugate was added to 1 of the HMP systems (treated group). A customized ex vivo normothermic oxygenated perfusion (NP) system with added exogenous creatinine was used to evaluate early kidney function. Blood, urine and histological samples were collected during the subsequent 3 hours of NP. Results Kidney weight was lower at the end of NP (p=0.017) in the treated group compared to control kidneys. The rate of decline in creatinine level was faster (p=0.024), total urinary volume was higher (p=0.031) and the level of urine neutrophil gelatinase-associated lipocalin (NGAL) was lower (p=0.031) in the treated group. Histologically, less tubular changes were seen (p=0.046). During NP intrarenal resistance remained lower (p

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