A Standardized Porcine Kidney Auto-transplant Protocol for Studying Delayed Graft Function

Delayed graft function (DGF) is commonly defined as the need for dialysis within 7 days after kidney transplantation; however, current definitions often rely on subjective clinical judgment and lack standardized criteria describing graft sufficiency accurately. This inconsistency hinders diagnosis and research comparisons. This protocol sets objective thresholds for DGF using quantifiable urine output and serum renal function values to objectively describe graft sufficiency and independent ability to maintain homeostasis. Research in swine models is challenging due to the absence of consensus diagnostic endpoints for DGF and the difficulty of performing dialysis for prolonged durations. To address this, we introduce a clearly defined protocol for defining and inducing DGF in porcine kidney auto-transplantation after 30 min of isolated renal warm ischemia, simulating donor after circulatory death (DCD)-like procurement. We describe non-invasive Foley catheterization, central venous access, and arterial line monitoring methods in female swine, allowing accurate urine output measurement, daily labs, and intraoperative monitoring. These techniques are detailed to ensure transparency and reproducibility, creating a standardized endpoint for DGF studies in swine that recapitulates the clinical phenotype.