Contrast enhanced computed tomography during normothermic machine perfusion of kidneys
*Matthew Harris1, *Jenna DiRito1,2, *Taras Lysyy1, *Shin Rong Lee1, *Nabil Boutagy1, *Susann Spindler1, Peter Yoo1, *Sarah Hosgood2, David Mulligan1, *Michael Nicholson2, *Albert Sinusas1, *Gregory Tietjen1, *Danielle Haakinson1
1Yale University School of Medicine, New Haven, CT;2University of Cambridge, Cambridge, United Kingdom
Objective:
To develop tools for non-invasive assessment of transplant-declined human kidneys using contrast-enhanced computed tomography (CT) during cold storage and normothermic machine perfusion (NMP).
Design:
Pilot
experimental study to establish feasibility and methodology
Setting:
Yale Translational Research Imaging Center
Participants:
9 transplant-declined human kidneys obtained from New England Donor Services under approved ethical protocol. 20 porcine kidneys procured from euthanized pigs at Yale animal research facilities under IUCUC approved protocols.
Intervention:
NMP and contrast-enhanced CT
Main Outcome:
Normalized accessible vascular volume
Results:
Performed contrast-enhanced CT on 20 porcine kidneys and 9 human kidneys using a constant pressure infusion with crystalloid after cold storage. Subsequently, perfused 2 pig and 2 human kidneys with oxygenated red blood cells at normothermic temperatures for 30 minutes using an adapted pediatric cardiac bypass circuit. During perfusion, performed contrast-enhanced CTs at early, mid, and late time points. Used custom MATLAB code to analyze DICOM images and calculate normalized contrast volumes to reflect accessible vasculature. Normalized vascular volume of one kidney increased 133% when imaged during NMP compared to prior cold storage imaging (Figure 1). 
Conclusions:
To our knowledge, this is the first described series of contrast-enhanced CT of ex-vivo human kidneys during NMP. Ex-vivo whole-organ CT is feasible during NMP and can enable dynamic, quantitative assessments of accessible vasculature and perfusion of marginal human kidneys. Our approach can be used before and after therapeutic interventions to control for the inherent variability of human organs.
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