Magnetic resonance imaging during warm ex vivo kidney perfusion

Background The shortage of donor organs for transplantation remains a worldwide problem. The utilization of suboptimal deceased donors enlarges the pool of potential organs, yet consequently, clinicians face the difficult decision of whether these sub-optimal organs are of sufficient quality for transplantation. Novel technologies could play a pivotal role in making pre-transplant organ assessment more objective and reliable. Methods Ex vivo normothermic machine perfusion (NMP) at temperatures around 35-37 degrees C allows organ quality assessment in a near-physiological environment. Advanced magnetic resonance imaging (MRI) techniques convey unique information about an organ's structural and functional integrity. The concept of applying magnetic resonance imaging during renal normothermic machine perfusion is novel in both renal and radiological research and we have developed the first MRI-compatible NMP setup for human-sized kidneys. Results We were able to obtain a detailed and real-time view of ongoing processes inside renal grafts during ex vivo perfusion. This new technique can visualize structural abnormalities, quantify regional flow distribution, renal metabolism, and local oxygen availability, and track the distribution of ex vivo administered cellular therapy. Conclusion This platform allows for advanced pre-transplant organ assessment, provides a new realistic tool for studies into renal physiology and metabolism, and may facilitate therapeutic tracing of pharmacological and cellular interventions to an isolated kidney.

Automated summary

This study introduces a novel technique of using MRI during ex vivo normothermic machine perfusion for renal grafts, allowing detailed real-time visualization and assessment of structural abnormalities, regional flow distribution, renal metabolism, local oxygen availability, and distribution of ex vivo administered cellular therapy. This platform provides an advanced tool for pre-transplant organ assessment and renal physiology and metabolism research.