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Title: Defining the limits of renal warm ischaemia in a porcine model
Author: Nortley , Mei
ISNI:       0000 0004 5372 4141
Awarding Body: St George's, University of London
Current Institution: St George's, University of London
Date of Award: 2015
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Prolonged renal warm ischaemia (WI) has functional implications both in transplantation and urological practice. Critical limits of WI are unknown. This study assesses biochemical changes during WI and functional limits of WI using microdialysis, cold pulsatile machine perfusion (CPMP) parameters, histological assessment, serum creatinine and estimated glomerular filtration (eGFR) rate in a porcine model. MATERIALS & METHODS: The left renal artery of female large-white pigs (45-75 kg) was clamped for 60, 90, 120, 150 or 180 minutes to simulate clinical WI. Microdialysis sampling was performed every 15 minutes before, during and after clamping. Samples were analysed for glucose, pyruvate, lactate and glycerol concentrations (CMA 600 Analyser, Lab Model, Sweden). After identical WI simulation on the right kidney a right nephrectomy was performed on day 7 and CPMP parameters measured for 2 hours. Histological assessment was performed at the end of WI (left and right kidneys), after one hour ofreperfusion (left kidneys), after 2 hours CPMP (right kidneys) and 4 weeks after left renal WI (left kidneys). "Recovery" was defined as return of serum creatinine concentration to within +50% of baseline by 4 weeks or eGFR to within 60ml/min. (License: PPL 70/6580-UK) Microdialysis markers, CPMP parameters, histological assessment, serum creatinine and eGFR were unable to stratify the duration of renal WI time suffered. Kidneys exposed to WI of 120 minutes or less achieved "recovery" but those exposed to over 150 minutes did not. A calculated projection suggests that all kidneys may have reached recovery at 7 weeks. All pigs survived the study period. CONCLUSIONS: This study suggests the critical limits lies between 120 and 150 minutes of WI although extrapolations from animal data should be made with caution. Microdialysis markers, whilst able to detect ischaemia, are not suitable for use as criteria for viability.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available