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Kaths JM, Echeverri J, Goldaracena N, Louis KS, Yip P, John R, Mucsi I, Ghanekar A, Bagli D, Selzner M, Robinson LA. Heterotopic Renal Autotransplantation in a Porcine Model: A Step-by-Step Protocol. J Vis Exp 2016:53765. [PMID: 26967919 PMCID: PMC4828178 DOI: 10.3791/53765] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Kidney transplantation is the treatment of choice for patients suffering from end-stage renal disease. It offers better life expectancy and higher quality of life when compared to dialysis. Although the last few decades have seen major improvements in patient outcomes following kidney transplantation, the increasing shortage of available organs represents a severe problem worldwide. To expand the donor pool, marginal kidney grafts recovered from extended criteria donors (ECD) or donated after circulatory death (DCD) are now accepted for transplantation. To further improve the postoperative outcome of these marginal grafts, research must focus on new therapeutic approaches such as alternative preservation techniques, immunomodulation, gene transfer, and stem cell administration. Experimental studies in animal models are the final step before newly developed techniques can be translated into clinical practice. Porcine kidney transplantation is an excellent model of human transplantation and allows investigation of novel approaches. The major advantage of the porcine model is its anatomical and physiological similarity to the human body, which facilitates the rapid translation of new findings to clinical trials. This article offers a surgical step-by-step protocol for an autotransplantation model and highlights key factors to ensure experimental success. Adequate pre- and postoperative housing, attentive anesthesia, and consistent surgical techniques result in favorable postoperative outcomes. Resection of the contralateral native kidney provides the opportunity to assess post-transplant graft function. The placement of venous and urinary catheters and the use of metabolic cages allow further detailed evaluation. For long-term follow-up studies and investigation of alternative graft preservation techniques, autotransplantation models are superior to allotransplantation models, as they avoid the confounding bias posed by rejection and immunosuppressive medication.
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Affiliation(s)
- J Moritz Kaths
- Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital; Division of Nephrology, The Hospital for Sick Children;
| | - Juan Echeverri
- Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital; Programa de Doctorat en Medicina, La Universitat Autónoma de Barcelona
| | - Nicolas Goldaracena
- Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital
| | - Kristine S Louis
- Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital
| | - Paul Yip
- Laboratory Medicine and Pathobiology, Toronto General Hospital
| | - Rohan John
- Laboratory Medicine and Pathobiology, Toronto General Hospital
| | - Istvan Mucsi
- Department of Medicine, Toronto General Hospital
| | - Anand Ghanekar
- Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital
| | - Darius Bagli
- Departments of Surgery (Urology) & Physiology, Developmental & Stem Cell Biology, The Hospital for Sick Children
| | - Markus Selzner
- Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital
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Faure A, Bruzzese L, Steinberg JG, Jammes Y, Torrents J, Berdah SV, Garnier E, Legris T, Loundou A, Chalopin M, Magalon G, Guieu R, Fenouillet E, Lechevallier E. Effectiveness of pure argon for renal transplant preservation in a preclinical pig model of heterotopic autotransplantation. J Transl Med 2016; 14:40. [PMID: 26847569 PMCID: PMC4743167 DOI: 10.1186/s12967-016-0795-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 01/20/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND In kidney transplantation, the conditions of organ preservation following removal influence function recovery. Current static preservation procedures are generally based on immersion in a cold-storage solution used under atmospheric air (approximately 78 kPa N2, 21 kPa O2, 1 kPa Ar). Research on static cold-preservation solutions has stalled, and modifying the gas composition of the storage medium for improving preservation was considered. Organoprotective strategies successfully used noble gases and we addressed here the effects of argon and xenon on graft preservation in an established preclinical pig model of autotransplantation. METHODS The preservation solution Celsior saturated with pure argon (Argon-Celsior) or xenon (Xenon-Celsior) at atmospheric pressure was tested versus Celsior saturated with atmospheric air (Air-Celsior). The left kidney was removed, and Air-Celsior (n = 8 pigs), Argon-Celsior (n = 8) or Xenon-Celsior (n = 6) was used at 4 °C to flush and store the transplant for 30 h, a duration that induced ischemic injury in our model when Air-Celsior was used. Heterotopic autotransplantation and contralateral nephrectomy were performed. Animals were followed for 21 days. RESULTS The use of Argon-Celsior vs. Air-Celsior: (1) improved function recovery as monitored via creatinine clearance, the fraction of excreted sodium and tubulopathy duration; (2) enabled diuresis recovery 2-3 days earlier; (3) improved survival (7/8 vs. 3/8 pigs survived at postoperative day-21); (4) decreased tubular necrosis, interstitial fibrosis, apoptosis and inflammation, and preserved tissue structures as observed after the natural death/euthanasia; (5) stimulated plasma antioxidant defences during the days following transplantation as shown by monitoring the "reduced ascorbic acid/thiobarbituric acid reactive substances" ratio and Hsp27 expression; (6) limited the inflammatory response as shown by expression of TNF-alpha, IL1-beta and IL6 as observed after the natural death/euthanasia. Conversely, Xenon-Celsior was detrimental, no animal surviving by day-8 in a context where functional recovery, renal tissue properties and the antioxidant and inflammation responses were significantly altered. Thus, the positive effects of argon were not attributable to the noble gases as a group. CONCLUSIONS The saturation of Celsior with argon improved early functional recovery, graft quality and survival. Manipulating the gas composition of a preservation medium constitutes therefore a promising approach to improve preservation.
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Affiliation(s)
- Alice Faure
- Department of Urology and Kidney Transplantation, Aix-Marseille University, APHM, Marseille, France.
| | - Laurie Bruzzese
- UMR MD2 & IRBA, Aix-Marseille University, Marseille, France.
| | | | - Yves Jammes
- UMR MD2 & IRBA, Aix-Marseille University, Marseille, France.
| | - Julia Torrents
- Department of Pathology, Aix-Marseille University, APHM, Marseille, France.
| | - Stephane V Berdah
- C.E.R.C, Aix-Marseille University, Faculty of Medicine, Marseille, France.
| | - Emmanuelle Garnier
- C.E.R.C, Aix-Marseille University, Faculty of Medicine, Marseille, France.
| | - Tristan Legris
- Department of Nephrology and Kidney Transplantation, Aix-Marseille University, APHM, Marseille, France.
| | - Anderson Loundou
- Public Health Laboratory, Aix-Marseille University, Marseille, France.
| | - Matthieu Chalopin
- Air Liquide Medical Gases Group, Air Liquide sante International-Claude Delorme Research Center, Jouy-en-Josas, France.
| | - Guy Magalon
- Department of Plastic Surgery, Aix-Marseille University, APHM, Marseille, France.
| | - Regis Guieu
- UMR MD2 & IRBA, Aix-Marseille University, Marseille, France.
| | - Emmanuel Fenouillet
- UMR MD2 & IRBA, Aix-Marseille University, Marseille, France. .,Institut des Sciences Biologiques, CNRS, Paris, France.
| | - Eric Lechevallier
- Department of Urology and Kidney Transplantation, Aix-Marseille University, APHM, Marseille, France.
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