H₂S-Enriched Flush out Does Not Increase Donor Organ Quality in a Porcine Kidney Perfusion Model

Kidney extraction time has a detrimental effect on post-transplantation outcome. This study aims to improve the flush-out and potentially decrease ischemic injury by the addition of hydrogen sulphide (H₂S) to the flush medium. Porcine kidneys (n = 22) were extracted during organ recovery surgery. Pigs underwent brain death induction or a Sham operation, resulting in four groups: donation after brain death (DBD) control, DBD H₂S, non-DBD control, and non-DBD H₂S. Directly after the abdominal flush, kidneys were extracted and flushed with or without H₂S and stored for 13 h via static cold storage (SCS) +/- H₂S before reperfusion on normothermic machine perfusion. Pro-inflammatory cytokines IL-1b and IL-8 were significantly lower in H₂S treated DBD kidneys during NMP (p = 0.03). The non-DBD kidneys show superiority in renal function (creatinine clearance and FENa) compared to the DBD control group (p = 0.03 and p = 0.004). No differences were seen in perfusion parameters, injury markers and histological appearance. We found an overall trend of better renal function in the non-DBD kidneys compared to the DBD kidneys. The addition of H₂S during the flush out and SCS resulted in a reduction in pro-inflammatory cytokines without affecting renal function or injury markers.