Magnetic resonance imaging as a noninvasive 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 journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

Abstract

Normothermic machine perfusion (NMP) is increasingly considered for pretransplant 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. 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 minutes 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. Ischemically injured ex vivo kidneys showed a significantly altered regional blood flow distribution compared to in vivo and minimally damaged organs. Both ex vivo groups showed diffusion restriction relative to in vivo. 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
ISSN1600-6135
DOIs
Publication statusAccepted/In press - Apr 2024

Keywords

  • kidney transplantation
  • magnetic resonance imaging
  • organ donation
  • renal normothermic machine perfusion

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