
Advances in organ storage techniques have revolutionized organ donation after cardiac death. These techniques, called normothermic regional perfusion (NRP), allow a transplant team to restore blood and oxygen to organs to help them recover normal physiologic activity before they are transplanted. This organ preservation technique has significantly increased organ utilization and improved outcomes for organ recipients, and its success is most pronounced in cases of liver transplantation. However, there are more than 100,000 Americans currently on the kidney transplant wait list. Division of Transplantation Assistant Professor David Aufhauser, MD, would like to improve the successful use of NRP for donor kidneys, and he’ll take the first steps toward doing so with a new one-year, $25,000 grant from the Association of Organ Procurement Organizations Foundation.
“Part of the reason NRP has been so successful with liver transplants is because we have robust tests that can tell us how viable the donor liver is. Similar tests do not yet exist for kidneys, and without these tests there’s a good chance that kidneys that could help people get off dialysis are going unused. With the number of people on the transplant list, we simply can’t afford to do that,” explained Aufhauser. “That’s why we want to identify markers of donor kidney viability during NRP – to help us determine the ‘health’ of the kidney so we can maximize the selection of kidneys that can be successfully transplanted, help honor our donors’ wishes that their organs be transplanted, and yield improved outcomes for the recipients.”
To look for these markers, Aufhauser and his co-Investigator, Division of Transplantation Assistant Professor Jennifer Philip, MD, will measure kidney-specific cell-free DNA (small fragments of kidney DNA that are found circulating in the bloodstream) at various timepoints during NRP and then assess whether these measurements are associated with post-transplant kidney function. They will also perform RNA sequencing of post-transplant biopsied kidney specimens to compare differential gene expression patterns in donated kidneys that were removed and stored using different techniques.
“NRP is the single most promising technology to reduce kidney transplant waitlists, but kidney-specific viability testing is critical to realize NRP’s full potential,” said Aufhasuer. “The enhanced kidney viability testing envisioned in our proposal can increase confidence in kidneys that are procured from higher-risk donors and can maximize utilization of donated kidneys to help alleviate long wait times on the transplant waitlist.”