Magnetic resonance imaging as a non-invasive adjunct to conventional assessment of functional differences between kidneys in vivo and during ex vivo normothermic machine perfusion

Tim L Hamelink*, Baran Ogurlu, Carolina C Pamplona, Johannes Castelein, Sigrid S Bennedsgaard, Haiyun Qi, Thomas Weiss, Veerle A Lantinga, Merel B F Pool, Christoffer Laustsen, Bente Jespersen, Henri G D Leuvenink, Steffen Ringgaard, Ronald J H Borra, Anna K Keller, Cyril Moers

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

INTRODUCTION: Normothermic machine perfusion (NMP) is increasingly considered for pre-transplant kidney quality assessment. However, fundamental questions about differences between in vivo and ex vivo renal function, as well as the impact of ischemic injury on ex vivo physiology, remain unanswered. This study utilized magnetic resonance imaging (MRI), alongside conventional parameters to explore differences between in vivo and ex vivo renal function and the impact of warm ischemia on a kidney's behavior ex vivo.

METHODS: Renal MRI scans and samples were obtained from living pigs (n=30) in vivo. Next, kidney pairs were procured and exposed to minimal, or 75 min of warm ischemia, followed by 6 hours of hypothermic machine perfusion. Both kidneys simultaneously underwent 6-hour ex vivo perfusion in MRI-compatible NMP circuits to obtain multiparametric MRI data.

RESULTS: Ischemically injured ex vivo kidneys showed a significantly altered regional blood flow distribution compared to in vivo and to minimally damaged organs. Both ex vivo groups showed diffusion restriction relative to in vivo.

CONCLUSION: Our findings underscore the differences between in vivo and ex vivo MRI-based renal characteristics. Therefore, when assessing organ viability during NMP, it should be considered to incorporate parameters beyond the conventional functional markers that are common in vivo.

Original languageEnglish
JournalAmerican Journal of Transplantation
DOIs
Publication statusE-pub ahead of print - 12-Apr-2024

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