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Ex Vivo Analysis of Kidney Graft Viability Using 31P Magnetic Resonance Imaging Spectroscopy
Alban Longchamp1, Antoine Klauser2,3, Julien Songeon2
1Department of Vascular Surgery, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.
Background:
The lack of organs for kidney transplantation is a growing concern. Expansion in organ supply has been proposed through the use of organs after circulatory death (donation after circulatory death [DCD]). However, many DCD grafts are discarded because of long warm ischemia times, and the absence of reliable measure of kidney viability. P magnetic resonance imaging (pMRI) spectroscopy is a noninvasive method to detect high-energy phosphate metabolites, such as ATP. Thus, pMRI could predict kidney energy state, and its viability before transplantation.
Methods:
To mimic DCD, pig kidneys underwent 0, 30, or 60 min of warm ischemia, before hypothermic machine perfusion. During the ex vivo perfusion, we assessed energy metabolites using pMRI. In addition, we performed Gadolinium perfusion sequences. Each sample underwent histopathological analyzing and scoring. Energy status and kidney perfusion were correlated with kidney injury.
Results:
Using pMRI, we found that in pig kidney, ATP was rapidly generated in presence of oxygen (100 kPa), which remained stable up to 22 h. Warm ischemia (30 and 60 min) induced significant histological damages, delayed cortical and medullary Gadolinium elimination (perfusion), and reduced ATP levels, but not its precursors (AMP). Finally, ATP levels and kidney perfusion both inversely correlated with the severity of kidney histological injury.
Conclusions:
ATP levels, and kidney perfusion measurements using pMRI, are biomarkers of kidney injury after warm ischemia. Future work will define the role of pMRI in predicting kidney graft and patient's survival.
Insights
Pulsed magnetic resonance imaging (pMRI) can assess kidney viability after warm ischemia. ATP levels and perfusion measured by pMRI correlate with kidney injury, aiding organ transplantation decisions.
Area of Science:
- Biomedical Engineering
- Transplantation Science
- Medical Imaging
Background:
- Organ shortage for kidney transplantation is critical.
- Donation after circulatory death (DCD) offers potential but faces challenges.
- DCD graft viability assessment is limited, leading to discard.
Purpose of the Study:
- To evaluate pulsed magnetic resonance imaging (pMRI) for assessing kidney viability.
- To correlate pMRI findings with kidney injury after warm ischemia.
Main Methods:
- Pig kidneys underwent simulated warm ischemia (0, 30, 60 min).
- Hypothermic machine perfusion and pMRI were used to assess energy metabolites (ATP) and perfusion.
- Histopathological analysis and Gadolinium perfusion sequences were performed.
Main Results:
- pMRI detected rapid ATP generation in oxygenated kidneys.
- Warm ischemia significantly damaged kidney histology and reduced ATP levels.
- Reduced ATP and impaired perfusion correlated with increased kidney injury.
Conclusions:
- pMRI-assessed ATP levels and kidney perfusion are reliable biomarkers of kidney injury.
- pMRI shows promise for predicting kidney graft viability in transplantation.
