Physiology of EVNP Sample Clauses

Physiology of EVNP. Despite placing organs in static cold storage, anaerobic metabolism continues resulting in toxic metabolites causing cellular odema and eventual necrosis. Hence the main physiological purpose of EVNP is to restore and maintain aerobic metabolism by offering leucocyte depleted, warm oxygenated blood based perfusate solution for organ preservation and re-conditioning, prior to implantation. The absence of leucocytes in the perfusate solution is a critical feature of EVNP. In a haemoperfused porcine kidney EVNP model, Xxxxxx et al (2006), showed that renal blood flow, oxygen consumption and acid- base homeostasis were improved by perfusion with leucocyte-depleted blood. The concluded that the depletion of leucocytes from the perfusion blood improved post- ischaemic renal function – implying that leucocytes have a pivotal role in ischaemia- reperfusion injury (107). These experiments were performed using autologous blood with a white blood cell filter incorporated into the experimental circuit. The optimal physiological conditions required for EVNP are largely undetermined and have been subject to experimental investigations. With respect to temperature, reports of sub-normothermic perfusion (32 degrees Celsius) in large animal models of renal EVNP have shown inferior tubular and renal function and preservation compared to near-physiological normothermic perfusion (108). In addition, determining the ideal arterial pressure in NMP has also been investigated. Xxxxx et al (2014) have shown that a mean arterial pressure of 75mmHg during EVNP resulted in better tubular function and reduced endothelial injury during ex vivo reperfusion compared with kidneys perfused at 55 mm Hg in a porcine EVNP kidney model (109). Xxxxxxxxx’x group use nutrients, vitamins and glucose as part of the perfusate solution for EVNP (110) as have other groups (111) to encourage cell repair, proliferation and metabolism. Using packed red blood cell units to create the blood based perfusate solution for EVNP still carries the theoretical risks of disease transmission and potential haemolysis. The ideal alternative to a blood based perfusate solution should offer oxygen carrying capabilities as well as buffers and solutions to help maintain homeostatic cellular function with physiological electrolyte levels. The acellular haemoglobin-based oxygen carrier, Hemopure has been shown to be an alternative source to packed red cells for liver NMP (112) but has not been used for renal EVNP to date.
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