Selective renal blood perfusion induces renal tubules injury in a porcine model Johannes Kalder, MD, Maria Kokozidou, DVM, MSc, PhD, Paula Keschenau,

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Selective renal blood perfusion induces renal tubules injury in a porcine model Johannes Kalder, MD, Maria Kokozidou, DVM, MSc, PhD, Paula Keschenau, MD, Miriam Tamm, Andreas Greiner, MD, PhD, Thomas A. Koeppel, MD, PhD, Rene Tolba, MD, PhD, Michael J. Jacobs, MD, PhD Journal of Vascular Surgery Volume 63, Issue 3, Pages 778-787 (March 2016) DOI: 10.1016/j.jvs.2014.08.116 Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 1 Experimental setting of the (a) distal aortic perfusion (DAP) and the (b and c) added selective renal perfusion (SRP). ECC, extracorporeal circulation. Journal of Vascular Surgery 2016 63, 778-787DOI: (10.1016/j.jvs.2014.08.116) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 2 Mean arterial blood pressure measurements were taken from the common carotid artery during the entire procedure in cohort I, and at times T1, T4, T5, and T6 in cohorts II and III. At T2 and T3, the pressure was measured in cohort II with an intra-aortic catheter below the thoracic aortic cross-clamp (TAC) and in cohort III at the tip of the perfusion catheters. The error bars show the standard deviation. DAP, Distal aortic perfusion; SOP, selective organ perfusion; T1, after surgical preparation; T2, beginning of the main procedure; T3, end of the main procedure; T4, 15 minutes of reperfusion; T5, 60 minutes of reperfusion; T6, 120 minutes of reperfusion. Journal of Vascular Surgery 2016 63, 778-787DOI: (10.1016/j.jvs.2014.08.116) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 3 Flow rates were measured during the experiment at the origins of both renal arteries. The plotted values are the added values of both renal arteries. During the selective renal perfusion (SRP) the flow rates were measured at the selective tubing system. The error bars show the standard deviation. DAP, Distal aortic perfusion; SOP, selective organ perfusion; T1, after surgical preparation; T2, beginning of the main procedure; T3, end of the main procedure; T4, 15 minutes of reperfusion; T5, 60 minutes of reperfusion; T6, 120 minutes of reperfusion; TAC, thoracic aortic cross-clamping. Journal of Vascular Surgery 2016 63, 778-787DOI: (10.1016/j.jvs.2014.08.116) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 4 Microcirculation measured by 15-μm fluorescent microspheres injected into the descending aorta or at T2 and T3 into the tubing system of the extracorporeal circulation (ECC) behind the oxygenator. The P values are given for log-transformed data (cohort I: n = 5, cohort II: n = 5, cohort III: n = 6). The error bars show the standard deviation. DAP, Distal aortic perfusion; SOP, selective organ perfusion; T1, after surgical preparation; T2, beginning of the main procedure; T3, end of the main procedure; T4, 15 minutes of reperfusion; TAC, thoracic aortic cross-clamping. Journal of Vascular Surgery 2016 63, 778-787DOI: (10.1016/j.jvs.2014.08.116) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 5 Calculated renal oxygen extraction ratio (O2ER) of the right kidney. The error bars show the standard deviation. DAP, Distal aortic perfusion; SOP, selective organ perfusion; T1, after surgical preparation; T2, beginning of the main procedure; T3, end of the main procedure; T4, 15 minutes of reperfusion; T5, 60 minutes of reperfusion; T6, 120 minutes of reperfusion; SRP, selective reperfusion; TAC, thoracic aortic cross-clamping. Journal of Vascular Surgery 2016 63, 778-787DOI: (10.1016/j.jvs.2014.08.116) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 6 A, Measured pH levels of the samples from the right renal vein. B, Calculated differences between renovenous and the aortic pH serum levels are shown. 1-Sensitivity analysis (without pig 10): P = .1232 (cohort I: n = 5, cohort II: n = 5; cohort III: n = 6). The error bars show the standard deviation. DAP, Distal aortic perfusion; SOP, selective organ perfusion; T1, after surgical preparation; T2, beginning of the main procedure; T3, end of the main procedure; T4, 15 minutes of reperfusion; T5, 60 minutes of reperfusion; T6, 120 minutes of reperfusion; TAC, thoracic aortic cross-clamping. Journal of Vascular Surgery 2016 63, 778-787DOI: (10.1016/j.jvs.2014.08.116) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 7 A, Measured base excess in mm/L from the venous sample of the right renal vein. B, Calculated difference between the renovenous base excess and the aortic base excess are shown in mmol/L. The error bars show the standard deviation. DAP, Distal aortic perfusion; SOP, selective organ perfusion; T1, after surgical preparation; T2, beginning of the main procedure; T3, end of the main procedure; T4, 15 minutes of reperfusion; T5, 60 minutes of reperfusion; T6, 120 minutes of reperfusion; TAC, thoracic aortic cross-clamping. Journal of Vascular Surgery 2016 63, 778-787DOI: (10.1016/j.jvs.2014.08.116) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 8 Measured creatinine serum levels. The error bars show the standard deviation. DAP, Distal aortic perfusion; SOP, selective organ perfusion; T1, after surgical preparation; T2, beginning of the main procedure; T3, end of the main procedure; T4, 15 minutes of reperfusion; T5, 60 minutes of reperfusion; T6, 120 minutes of reperfusion; TAC, thoracic aortic cross-clamping. Journal of Vascular Surgery 2016 63, 778-787DOI: (10.1016/j.jvs.2014.08.116) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 9 A, Measured renovenous neutrophil gelatinase-associated lipocalin (NGAL) levels (cohort I: n = 4, cohort II, n = 4; cohort III: n = 5). B, Urinary creatinine normalized urinary NGAL levels (cohort I: n = 3, cohort II: n = 2, cohort III: n = 5). The error bars show the standard deviation. DAP, Distal aortic perfusion; SOP, selective organ perfusion; T1, after surgical preparation; T2, beginning of the main procedure; T3, end of the main procedure; T4, 15 minutes of reperfusion; T5, 60 minutes of reperfusion; T6, 120 minutes of reperfusion; TAC, thoracic aortic cross-clamping. Journal of Vascular Surgery 2016 63, 778-787DOI: (10.1016/j.jvs.2014.08.116) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 10 A, Serum free hemoglobin values. B, Lactate dehydrogenase (LDH) levels (cohort I: n = 4, cohort II: n = 6, cohort III: n = 6). The error bars show the standard deviation. DAP, Distal aortic perfusion; SOP, selective organ perfusion; T1, after surgical preparation; T2, beginning of the main procedure; T3, end of the main procedure; T4, 15 minutes of reperfusion; T5, 60 minutes of reperfusion; T6, 120 minutes of reperfusion; TAC, thoracic aortic cross-clamping. Journal of Vascular Surgery 2016 63, 778-787DOI: (10.1016/j.jvs.2014.08.116) Copyright © 2016 Society for Vascular Surgery Terms and Conditions