The Hemopurifier removes extracellular vesicles and microRNAs from renal perfusates following controlled oxygenated rewarming of discarded donor kidneys

Abstract Kidney transplantation is considered the benchmark treatment for end-stage kidney disease patients. Nevertheless, the demand for donor kidneys is continuously on the rise and the scarcity of suitable kidneys poses a significant hindrance for patients and healthcare providers. One approach is to extend the criteria for the use of kidneys from deceased brain death and deceased circulatory death donors. Use of these organs especially from these extended criteria donors is associated with ischemia reperfusion injury (IRI) and resultant delayed graft function (DGF) as well as increased rates of allograft rejection. One approach to try to lessen these complications as well as increase the time the assessment of organ viability is the use of machine perfusion on recovered kidneys. In this study we obtained perfusates from discarded organs that had undergone Controlled Oxygenated Rewarming. Perfusates were analyzed for extracellular vesicles (EVs), dsDNA associated with EVs and microRNAs. These perfusates were then pumped over the Aethlon Hemopurifier, a plasma separator with an affinity resin containing the lectin Galanthus nivalis agglutinin (GNA). Following treatment with the Hemopurifier, a diminution in extracellular vesicles, dsDNA associated with EVs and microRNAs was observed. These results support a future study of the Aethlon Hemopurifier as part of a machine perfusion circuit to explore if the device decreases these mediators in a dynamic circuit and is associated with improved function of retrieved kidneys.