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Improving the quality of kidneys from non-heartbeating donors, using streptokinase: An animal model

Lookup NU author(s): Muhammed Gok, Dr Brian Shenton, Dr Helen Robertson, Dr Marie Mathers, Dr Doug Aitchison, Professor John Dark, Dr David Mantle, David Talbot

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Abstract

Background. Non-heart-beating donors (NHBD) offer a promising potential to increase the cadaveric organ donor pool, especially, for kidneys. However, almost half of NHBD kidneys are discarded after viability assessment. This wastage is costly in both human and monetary terms. Intravascular thrombosis at the time of donor death is an event leading to failure in the viability assessment. We have developed an animal model to investigate the effects of the addition of streptokinase to the in situ flush medium before transplant in an attempt to redress the situation. Methods. Two groups of eight healthy young Landrace Yorkshire white pigs were entered into the study. Both groups were subjected to approximately 70 min warm ischemia. Both groups received an intravascular flush with 4 L of Marshall's solution with heparin (1000 IU/L); one group of pigs also had streptokinase (1.5 MIU/L) added. After donor nephrectomy, all kidneys were machine perfused for 4 hr. Data on perfusion characteristics were taken and samples of kidney effluent were assayed for tissue damage biomarkers, glutathione S-transferase (GST) and alanine aminopeptidase (Ala-AP). Wedge sections of porcine kidneys were taken at the end of perfusion, for histological analysis. Results. Data on machine perfusion parameters (temperature, mean pressure index, resistance) indicate better cooling, lower resistance, and lower mean pressure index in the streptokinase-treated group of pigs. GST and Ala-AP levels were increased in the nonstreptokinase group perfusates. Histopathological analysis of porcine kidneys indicated more ischemic injury and tissue damage in the nonstreptokinase group. Conclusion. The use of streptokinase in this porcine NHBD model conferred benefits to donor kidneys when assessed by machine perfusion. Markers of bio-chemical injury indicated that less renal tissue damage occurred with the incorporation of streptokinase in the in situ flush medium.


Publication metadata

Author(s): Gok MA; Dark JH; Aitchison JD; Shenton BK; Robertson H; Mantle D; Peaston R; Cornell C; Mathers M; Talbot D

Publication type: Article

Publication status: Published

Journal: Transplantation

Year: 2002

Volume: 73

Issue: 12

Pages: 1869-1874

ISSN (print): 0041-1337

ISSN (electronic): 1534-6080

Publisher: Lippincott Williams & Wilkins

URL: http://dx.doi.org/10.1097/00007890-200206270-00003

DOI: 10.1097/00007890-200206270-00003


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