Kidney Procurement in a Preclinical Large Animal Model

Eleni M. Drivas; Amanda H. Loftin; Siavash Khaki; Alexandrea L. Bailey; Michael Wallis; Jessica Izzi; Byoung Chol Oh; Gerald Brandacher

doi:10.3791/67835

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Method Article

Kidney Procurement in a Preclinical Large Animal Model

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DOI:

10.3791/67835

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May 2nd, 2025

Eleni M. Drivas¹ , Amanda H. Loftin¹^,² , Siavash Khaki¹ , Alexandrea L. Bailey³ , Michael Wallis³ , Jessica Izzi³ , Byoung Chol Oh^*¹ , Gerald Brandacher^*¹^,⁴

¹Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, ²Department of Pathology, Johns Hopkins University School of Medicine, ³Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, ⁴Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University

^* These authors contributed equally

Summary

Here, we present a protocol that details a surgical model for kidney procurement in a preclinical swine model for subsequent machine perfusion or transplantation.

Abstract

Machine perfusion has evolved as a viable strategy for ex vivo organ assessment, monitoring, treatment, optimization, as well as to prolong preservation times. Large animal models have been paramount for the development and optimization of these technologies. However, in order to ensure graft quality and data reproducibility, standardized and clinically translatable surgical techniques for organ and tissue procurement should be followed. Thus, here, we describe an optimized protocol for kidney procurement in a preclinical swine model. Kidney recovery is performed using mixed breed (Yorkshire cross/mix) pigs. Briefly, following sterile disinfection and draping of the surgical field, a complete midline incision is performed to gain optimal access to both kidneys. The ureter, renal vein, and artery are dissected until their origin from the inferior vena cava and the aorta, respectively. After complete renal dissection, the ureter is tied and cut distally. The donor animal is then fully heparinized with 100 IU per kg/body weight. Next, the renal artery is clamped close to the aorta, and the renal vein is clamped close to the vena cava using a Satinsky vascular clamp. The kidney graft is then resected, and the renal artery is immediately cannulated back table. The kidney will then be flushed with an ice-cold preservation solution and stored on ice until either machine perfusion or transplantation. Finally, the renal artery stump is ligated with a 2-0 silk ligature, and the vena cava is closed with a 6-0 polypropylene suture. This technique recovers kidneys and simulates either a living (single kidney) or deceased (dual kidney) donor setting. The single kidney recovery offers the advantage to perform a subsequent autotransplantation. In the deceased donor model, blood can be collected prior to euthanasia by inserting blood bag needles directly into the aorta, thereby exsanguinating the animal and providing blood for ex vivo machine perfusion.

Introduction

Kidney transplantation is the optimal treatment for end-stage renal disease (ESRD), providing improved quality of life and long-term outcomes as compared to dialysis¹. Despite advances in organ preservation, dozens of people die each day from ESRD while on the waitlist for a kidney transplant². Machine perfusion is a growing field that increases preservation times, enabling extended donor networks and more efficient organ allocation. This technology also allows for ex vivo organ monitoring and optimization, thereby minimizing the effects of ischemia-reperfusion injury (IRI). When compared to static cold storage ....