Pretransplantation assessment of renal viability with NADH fluorimetry

Background. A pathophysiologic feature possibly involved in ischemic injury in transplant kidneys is mitochondrial dysfunction caused by disintegration of oxidative metabolic pathways. Because the ability to synthesize ATP by respiratory activity determines the organ's capacity to recover from ischemic injury, an assessment of respiratory activity may provide information related to graft viability. Methods. NADH fluorimetry can be used to monitor kidney cortex metabolism noninvasively. During perfusion with (an)-aerobic perfusate, NADH fluorescence images were recorded. We evaluated the NADH oxidation kinetics of 20 rat kidneys, which were divided over four experimental groups. For six minimally damaged kidneys and six kidneys that had been stored for one hour at 37 degrees C, perfusion was followed by transplantation. We related the kinetic parameters of these kidneys with their post-transplantation function and histology. The transplant function was monitored by serum creatinine and urea levels. Results. Storage of transplant kidneys for one hour at 37 degrees C significantly reduced the post-transplantation function. Isolated perfusion of grafts, however, was not detrimental for renal function. The rate of NADH oxidation decreased with decreasing graft quality, and a good correlation between NADH oxidation kinetics and post-transplantation function was found. Conclusions. A reduction of NADH oxidation rates as a consequence of warm ischemia supports the view that mitochondrial respiratory activity is impaired by ischemic injury. The correlation between NADH oxidation kinetics in perfused grafts and their post-transplantation function indicates that NADH fluorimetry may be useful in predicting the viability of preserved grafts prior to transplantation.