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. 2024 Aug;48(8):862-875.
doi: 10.1111/aor.14750. Epub 2024 Mar 28.

The association between hemoglobin levels and renal function parameters during normothermic machine perfusion: A retrospective cohort study using porcine kidneys

L Annick van Furth  1 , Tobias M Huijink  1 , L Leonie van Leeuwen  1   2 , Hanno Maassen  1 , Veerle A Lantinga  1 , Baran Ogurlu  1 , Tim L Hamelink  1 , Merel B F Pool  1 , Rianne Schutter  1 , Susanne Z J Veldhuis  1 , Petra J Ottens  1 , Cyril Moers  1 , Stefan P Berger  3 , Henri G D Leuvenink  1 , Rene A Posma  4 , Leonie H Venema  1
Affiliations

The association between hemoglobin levels and renal function parameters during normothermic machine perfusion: A retrospective cohort study using porcine kidneys

L Annick van Furth et al. Artif Organs. 2024 Aug.

Abstract

Background: Ex vivo normothermic machine perfusion (NMP) is a promising tool for assessing an isolated kidney prior to transplantation. However, there is no consensus on the perfusate's optimal oxygen-carrying capacity to support renal function. To investigate the association of hemoglobin levels with renal function parameters, a retrospective analysis of isolated, normothermically, perfused porcine kidneys was performed.

Methods: Between 2015 and 2021, a total of 228 kidneys underwent 4 h of NMP with perfusates that varied in hemoglobin levels. A generalized linear model was used to determine the association of hemoglobin levels with time-weighted means of renal function markers, such as fractional sodium excretion (FENa) and creatinine clearance (CrCl). Stratified by baseline hemoglobin level (<4.5, 4.5-6, or >6 mmol/L), these markers were modeled over time using a generalized linear mixed-effects model. All models were adjusted for potential confounders.

Results: Until a hemoglobin level of around 5 mmol/L was reached, increasing hemoglobin levels were associated with superior FENa and CrCl. Thereafter, this association plateaued. When hemoglobin levels were categorized, hemoglobin <4.5 mmol/L was associated with worse renal function. Hemoglobin levels were neither significantly associated with proteinuria during NMP nor with ATP levels at the end of NMP. Hemoglobin levels >6 mmol/L showed no additional benefits in renal function.

Conclusion: In conclusion, we found an association between baseline hemoglobin levels and superior renal function parameters, but not injury, during NMP of porcine kidneys. Furthermore, we show that performing a retrospective cohort study of preclinical data is feasible and able to answer additional questions, reducing the potential use of laboratory animals.

Keywords: hemoglobin; normothermic machine perfusion; porcine; renal function; retrospective cohort.

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References

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