The clinical benefits and metabolic mechanisms of ex vivo machine perfusion of kidneys prior to transplantation.

Download Statistics

Downloads

Downloads per month over past year

Nath, Jay (2017). The clinical benefits and metabolic mechanisms of ex vivo machine perfusion of kidneys prior to transplantation. University of Birmingham. Ph.D.

Preview

Nath17PhD_redacted.pdf
PDF - Redacted Version
Download (13MB)

Abstract

Hypothermic machine perfusion (HMP) is well established in the practice of renal transplantation and is associated with improved short and long-term outcomes for selected organs. Despite the advantages of this therapy during the period prior to transplantation, the mechanisms by which these benefits occur are not entirely clear and are likely to include factors additional to improved flow dynamics.
In the first part of this thesis, using both a local and national transplant dataset, I aim to establish the benefits (if any) and rationale for HMP relevant to current UK practice for both deceased and live donor kidneys.
In the second part of this thesis the mechanisms by which HMP exert benefit are further interrogated, with a particular focus on metabolism. Nuclear magnetic resonance (NMR) spectroscopy is the principal modality through which this is investigated and in addition to established 1D 1H NMR protocols, glucose tracer studies using 2D 13C NMR are described. Whole organ ex vivo perfusion is studied in this work using human kidneys (both transplanted and non-transplanted) and porcine organs, with the porcine model validated for metabolic studies.
In the final section, methods to modify metabolism during HMP are attempted, with the effects of supplemental oxygenation described.

Type of Work:

Thesis (Doctorates > Ph.D.)

Award Type:

Doctorates > Ph.D.

Supervisor(s):