Optimal Flow and Pressure Management in Machine Perfusion Systems for Organ Preservation

Intra-organ flow is the most critical parameter in machine-perfused organ preservation systems (MPS). Ultrasonic flow sensors (UFS) are commonly employed in MPS. However, UFS are sensitive to changes in fluid composition and temperature and require recalibration. Novel Coriolis-type mass flow sensors (CFS) may be more suitable for MPS because the measurement technique is not amenable to these factors. The effect of viscosity, colloids, temperature, pressure, and preservation solution on flow measurement accuracy of UFS and CFS was therefore investigated. A CFS-based MPS was built and validated for setpoint stability using porcine kidneys and the ability to reproduce different pressure and flow waveforms. The UFS exhibited a temperature- and preservation solution-dependent overestimation of flow rate compared to the CFS. The CFS deviated minimally from the actual flow rate and did not require recalibration. The CFS-based MPS conformed to the preprogrammed temperature, flow, pressure, and vascular resistance settings during 6-h kidney preservation. The system was also able to accurately reproduce different pressure and flow waveforms. Conclusively, CFS-based MPS are more suitable for organ preservation than UFS-based MPS. Our CFS-based MPS provides a versatile yet robust experimental platform for testing and validating different types of clinical and experimental MPS.

[1]  M. Yarmush,et al.  Subnormothermic machine perfusion at both 20°C and 30°C recovers ischemic rat livers for successful transplantation. , 2012, The Journal of surgical research.

[2]  M. Anklin,et al.  Coriolis mass flowmeters: Overview of the current state of the art and latest research , 2006 .

[3]  T. V. van Gulik,et al.  Appraisal of the porcine kidney autotransplantation model. , 2012, Frontiers in bioscience.

[4]  C. R. White,et al.  The scaling and temperature dependence of vertebrate metabolism , 2006, Biology Letters.

[5]  Roger C. Baker,et al.  Flow Measurement Handbook: Industrial Designs, Operating Principles, Performance, and Applications , 2000 .

[6]  M. Nicholson,et al.  First in Man Renal Transplantation After Ex Vivo Normothermic Perfusion , 2011, Transplantation.

[7]  P. Neuhaus,et al.  The influence of storage temperature during machine perfusion on preservation quality of marginal donor livers. , 2010, Cryobiology.

[8]  T. V. van Gulik,et al.  Pulsatile perfusion preservation of warm ischaemia‐damaged experimental kidney grafts , 2010, The British journal of surgery.

[9]  D. Lifshitz,et al.  Microparticulate ice slurry for renal hypothermia: laparoscopic partial nephrectomy in a porcine model. , 2010, Urology.

[10]  B. Winkens,et al.  Renovascular Resistance of Machine‐Perfused DCD Kidneys Is Associated with Primary Nonfunction , 2011, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[11]  S. Tullius,et al.  Hypothermic kidney preservation: a remembrance of the past in the future? , 2011, Current opinion in organ transplantation.

[12]  M. Ivimey Annual report , 1958, IRE Transactions on Engineering Writing and Speech.

[13]  J. Squifflet,et al.  The Prognostic Value of Renal Resistance During Hypothermic Machine Perfusion of Deceased Donor Kidneys , 2011, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[14]  M. Nicholson,et al.  Normothermic kidney preservation , 2011, Current opinion in organ transplantation.

[15]  L. H. Thomas,et al.  The dependence of the viscosities of liquids on reduced temperature, and a relation between viscosity, density, and chemical constitution. , 1946, Journal of the Chemical Society.

[16]  S. McLelland,et al.  A new method for evaluating errors in high‐frequency ADV measurements , 2000 .

[17]  P. Friend,et al.  The role of normothermic extracorporeal perfusion in minimizing ischemia reperfusion injury. , 2012, Transplantation reviews.

[18]  M. Stegall,et al.  Determinants of Discard of Expanded Criteria Donor Kidneys: Impact of Biopsy and Machine Perfusion , 2008, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[19]  J. Southard,et al.  The future of kidney preservation. , 1980, Transplantation.

[20]  E. Hinch,et al.  Experimental and numerical investigations of flow structure and momentum transport in a turbulent buoyancy-driven flow inside a tilted tube , 2009 .

[21]  M. Nicholson,et al.  Intra-renal resistance reflects warm ischaemic damage, and is further increased by static cold storage: a model of non-heart-beating donor kidneys. , 2003, Medical Science Monitor.

[22]  Marcelo Cypel,et al.  Normothermic ex vivo lung perfusion in clinical lung transplantation. , 2011, The New England journal of medicine.

[23]  Kunkel Jm,et al.  Spontaneous subclavain vein thrombosis: a successful combined approach of local thrombolytic therapy followed by first rib resection. , 1989 .