{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T20:30:28Z","timestamp":1786480228821,"version":"build-2736575974"},"reference-count":33,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","license":[{"start":{"date-parts":[[2025,5,7]],"date-time":"2025-05-07T00:00:00Z","timestamp":1746576000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Kidney360"],"published-print":{"date-parts":[[2025,9]]},"abstract":"\n Key Points<\/jats:title>\n \n \n \n Compared with whole blood (WB) kidneys perfused with a packed red blood cells perfusate exhibited superior kidney functional parameters.<\/jats:p>\n <\/jats:list-item>\n \n Metabolomics assessment showed drastic metabolic aberration in the WB group involving amino acid, carbohydrate, and mitochondrial energy metabolism.<\/jats:p>\n <\/jats:list-item>\n \n Tissue lipid profiling demonstrated that WB was associated with accumulation of tissue membrane\/structure components including glycerolipids and ceramides.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Background<\/jats:title>\n \n Ex vivo<\/jats:italic>\n normothermic perfusion (EVNP) with a blood-based perfusate has the potential to both assess viability of and repair high-risk organs before transplantation. The optimal perfusate is yet to be established.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We assessed hemodynamic, functional, and metabolic changes of eight paired high-risk human kidneys perfused with either a leukocyte-depleted packed red blood cell (PRBC) or a whole blood (WB) perfusate during a 3-hour EVNP.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n After a mean cold ischemia time of 54 hours, all kidneys showed high renal blood flow through perfusion. Renal resistance increased for both groups during the first hour and then decreased to similar terminal values. The kidneys perfused with PRBC had 55 ml\/min greater renal blood flow (95% confidence interval, 21 to 89;\n P<\/jats:italic>\n = 0.004) and higher total urine output (145 versus 25 ml,\n P<\/jats:italic>\n = 0.002) compared with the WB group. Urinary acute kidney biomarkers of neutrophil gelatinase-associated lipocalin and kidney injury molecule-1 were also significantly lower (mean differences of 281 and 2.1 ng\/ml, respectively;\n P<\/jats:italic>\n < 0.01) in the PRBC perfused kidneys. Compared with PRBC, within-group tissue metabolic profiling revealed a similar (23% versus 18%) but a more pronounced alteration involving (branched chain) amino acid and mitochondrial energy metabolism in the WB group. Similarly, lipid profile temporal changes showed that WB groups were highlighted by elevation of plasma membrane and structure lipids including glycerolipids, sphingolipids, and steroids. The PRBC group had minimal temporal tissue lipid profile changes.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Compared with WB, PRBC perfusion is superior in mitigating postischemia damage and facilitating function and metabolic recovery of high-risk kidneys subjected to long cold ischemia times during a 3-hour EVNP.<\/jats:p>\n <\/jats:sec>","DOI":"10.34067\/kid.0000000815","type":"journal-article","created":{"date-parts":[[2025,5,7]],"date-time":"2025-05-07T12:00:47Z","timestamp":1746619247000},"page":"1573-1585","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Packed Red Blood Cell and Whole Blood Perfusates during Ex Vivo Normothermic Perfusion for Assessment of High-Risk Donor Kidneys"],"prefix":"10.34067","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7711-2356","authenticated-orcid":false,"given":"Armin","family":"Ahmadi","sequence":"first","affiliation":[{"name":"Division of Nephrology, Department of Medicine, University of California, Davis, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1278-0150","authenticated-orcid":false,"given":"Heiko","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Urology, University of California San Francisco, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2815-5912","authenticated-orcid":false,"given":"Kuang-Yu","family":"Jen","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, University of California at Davis, Sacramento, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sili","family":"Fan","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, School of Medicine, University of California, Davis, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1386-0742","authenticated-orcid":false,"given":"Ivonne","family":"Palma","sequence":"additional","affiliation":[{"name":"Division of Transplant, Department of Surgery, University of California Davis Health, Sacramento, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5703-4936","authenticated-orcid":false,"given":"Junichiro","family":"Sageshima","sequence":"additional","affiliation":[{"name":"Division of Transplant, Department of Surgery, University of California Davis Health, Sacramento, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5642-7252","authenticated-orcid":false,"given":"Naeem","family":"Goussous","sequence":"additional","affiliation":[{"name":"Division of Transplant, Department of Surgery, University of California Davis Health, Sacramento, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baback","family":"Roshanravan","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, University of California, Davis, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-6598-5654","authenticated-orcid":false,"given":"Richard V.","family":"Perez","sequence":"additional","affiliation":[{"name":"Division of Transplant, Department of Surgery, University of California Davis Health, Sacramento, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,5,7]]},"reference":[{"issue":"Suppl s1","key":"B1-20251006","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1111\/ajt.15672","article-title":"OPTN\/SRTR 2018 annual data report: kidney","volume":"20","author":"Hart","year":"2020","journal-title":"Am J Transplant."},{"issue":"2","key":"B2-20251006","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1097\/TP.0000000000002299","article-title":"Combined ex vivo hypothermic and normothermic perfusion for assessment of high-risk deceased donor human kidneys for transplantation","volume":"103","author":"Kabagambe","year":"2019","journal-title":"Transplantation."},{"issue":"21","key":"B3-20251006","doi-asserted-by":"crossref","first-page":"2726","DOI":"10.1001\/jama.294.21.2726","article-title":"Deceased-donor characteristics and the survival benefit of kidney 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Programme","volume":"27","author":"Gallinat","year":"2012","journal-title":"Nephrol Dial Transplant."},{"issue":"6","key":"B7-20251006","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1111\/j.1432-2277.2011.01232.x","article-title":"Machine perfusion versus cold storage for preservation of kidneys from expanded criteria donors after brain death","volume":"24","author":"Treckmann","year":"2011","journal-title":"Transpl Int."},{"key":"B8-20251006","doi-asserted-by":"crossref","first-page":"1117292","DOI":"10.3389\/fimmu.2023.1117292","article-title":"Hypothermic machine perfusion alleviates ischemia-reperfusion injury of intestinal transplantation in pigs","volume":"14","author":"Hou","year":"2023","journal-title":"Front Immunol."},{"key":"B9-20251006","doi-asserted-by":"crossref","first-page":"848352","DOI":"10.3389\/fimmu.2022.848352","article-title":"The effect of hypothermic machine perfusion to ameliorate ischemia-reperfusion injury in donor organs","volume":"13","author":"Knijff","year":"2022","journal-title":"Front Immunol."},{"issue":"5","key":"B10-20251006","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1111\/aor.13364","article-title":"Hypothermic machine perfusion versus static cold storage in deceased donor kidney transplantation: a systematic review and meta-analysis of randomized controlled trials","volume":"43","author":"Peng","year":"2019","journal-title":"Artif Organs."},{"issue":"1","key":"B11-20251006","doi-asserted-by":"crossref","first-page":"6063","DOI":"10.1038\/s41598-020-62979-9","article-title":"Hypothermic oxygenated new machine perfusion system in liver and kidney transplantation of extended criteria donors: first Italian clinical trial","volume":"10","author":"Ravaioli","year":"2020","journal-title":"Sci Rep."},{"issue":"1","key":"B12-20251006","doi-asserted-by":"crossref","first-page":"5","DOI":"10.2217\/fca-2021-0030","article-title":"Ex vivo normothermic perfusion in heart 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Int."},{"issue":"4","key":"B28-20251006","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1016\/j.kint.2022.11.020","article-title":"Untargeted metabolomics of perfusate and their association with hypothermic machine perfusion and allograft failure","volume":"103","author":"Liu","year":"2023","journal-title":"Kidney Int."},{"issue":"9","key":"B29-20251006","doi-asserted-by":"crossref","first-page":"1252","DOI":"10.1681\/ASN.0000000000000403","article-title":"Serum and urine metabolites and kidney function","volume":"35","author":"Yeo","year":"2024","journal-title":"J Am Soc Nephrol."},{"issue":"1","key":"B30-20251006","doi-asserted-by":"crossref","first-page":"15422","DOI":"10.1038\/s41598-017-15761-3","article-title":"Metabolomics identifies metabolite biomarkers associated with acute rejection after heart transplantation in rats","volume":"7","author":"Lin","year":"2017","journal-title":"Sci Rep."},{"issue":"1","key":"B31-20251006","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1038\/s41387-022-00213-3","article-title":"Role of branched-chain amino acid metabolism in the pathogenesis of obesity and type 2 diabetes-related metabolic disturbances BCAA metabolism in type 2 diabetes","volume":"12","author":"Vanweert","year":"2022","journal-title":"Nutr Diabetes."},{"issue":"11","key":"B32-20251006","doi-asserted-by":"crossref","first-page":"1433","DOI":"10.1002\/bjs.9894","article-title":"Ex vivo normothermic perfusion for quality assessment of marginal donor kidney transplants","volume":"102","author":"Hosgood","year":"2015","journal-title":"Br J Surg."},{"key":"B33-20251006","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1186\/s12967-015-0691-x","article-title":"The use of ex-vivo normothermic perfusion for the resuscitation and assessment of human kidneys discarded because of inadequate in situ perfusion","volume":"13","author":"Hosgood","year":"2015","journal-title":"J Transl Med."}],"container-title":["Kidney360"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.34067\/KID.0000000815","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T19:59:03Z","timestamp":1786478343000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.34067\/KID.0000000815"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,7]]},"references-count":33,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.34067\/kid.0000000815","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2024.10.18.24315776","asserted-by":"object"}]},"ISSN":["2641-7650"],"issn-type":[{"value":"2641-7650","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,7]]},"assertion":[{"value":"2025-01-02","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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