Soluble Thrombomodulin as a Marker of Endothelial Injury in Early Post-Transplant Period - A Comparative Study of Simple Hypothermia and Pulsatile Machine Perfusion in Kidney Graft Preservation

Q: Did the study find differences in early graft function between groups?

Early renal function parameters improved in both groups, and no significant inter-group differences were reported. No delayed graft function or graft thrombosis occurred.

Sep 30, 2026

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Ischemia–reperfusion injury drives early graft dysfunction after kidney transplantation and is linked to endothelial damage measurable through circulating soluble thrombomodulin (sTM). This exploratory paired-kidney study evaluates very early renal vein sTM dynamics during reperfusion using static cold storage (SCS) versus hypothermic machine perfusion (HMP). Renal vein samples were collected at 1 and 30 minutes after reperfusion, sTM quantified by ELISA, and early graft function tracked for 7 days. HMP showed sTM reduction between 1–30 minutes, while SCS remained stable; early graft function improved in both groups with no significant inter-group differences. Sample-size limits restricted detection of between-group effects, suggesting very-early sTM measurement as insight into IRI requiring larger validation.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages15

Reading Time38 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusions

1. Introduction

Chronic kidney disease and transplantation context

Ischemia–reperfusion injury and preservation strategies

Role of soluble thrombomodulin as a biomarker

Article Soluble Thrombomodulin as a Marker of Endothelial Injury in Early Post-Transplant Period: A Comparative Study of Simple Hypothermia and Pulsatile Machine Perfusion in Kidney Graft Preservation Maciej Kotowski 1,†, Anna Prekwa 1,†, Adam Nowacki 2, Iga Stukan 3, *, Karol Tejchman 1, Jerzy Sie ´nko 4, Przemysław Nowacki 5, Bogusław Machali ´nski 3 and Marek Ostrowski 1 Academic Editor: Pierluigi Marzuillo Received: 12 November 2025 Revised: 21 December 2025 Accepted: 26 December 2025 Published: 29 December 2025 Copyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. 1 Department of General Surgery and Transplantation, Pomeranian Medical University, 70-111 Szczecin, Poland; [maciej.j.kotowski@gmail.com](maciej.j.kotowski@gmail.com) (M.K.); [annaprekwa@gmail.com](annaprekwa@gmail.com) (A.P.); [ktejchman78@gmail.com](ktejchman78@gmail.com) (K.T.); [mostrowski@poczta.onet.pl](mostrowski@poczta.onet.pl) (M.O.) 2 Department of Vascular Surgery, General Surgery and Angiology, Pomeranian Medical University, 70-111 Szczecin, Poland; [itskorn@gmail.com](itskorn@gmail.com) 3 Department of General Pathology, Pomeranian Medical University, 70-111 Szczecin, Poland; [boguslaw.machalinski@pum.edu.pl](boguslaw.machalinski@pum.edu.pl) 4 Department of General, Transplant and Liver Surgery, Pomeranian Medical University, 71-455 Szczecin, Poland; [jsien@poczta.onet.pl](jsien@poczta.onet.pl) 5 Department of Neurology, Pomeranian Medical University, 71-252 Szczecin, Poland; [nowackiprz@gmail.com](nowackiprz@gmail.com) * Correspondence: [iga.stukan@pum.edu.pl](iga.stukan@pum.edu.pl); Tel.: +48-91-466-1535 † These authors contributed equally to this work. Abstract Background: Ischemia–reperfusion injury is a major contributor to early graft dysfunction after kidney transplantation and is associated with endothelial damage, reflected by circulating soluble thrombomodulin (sTM). This exploratory study aimed to assess very early graft-level changes in renal vein sTM during reperfusion using a paired-kidney design, in which kidneys from the same donor were preserved using different strategies: static cold storage (SCS) and hypothermic machine perfusion (HMP) . Methods: Renal vein blood samples were collected intraoperatively at 1 and 30 min after reperfusion. Plasma sTM concentrations were determined using ELISA. Early graft function was monitored during the first 7 days post-transplantation. Results: Cold ischemia time was longer in the HMP group than in the SCS group (20 ± 8 h vs. 13 ± 6 h, p < 0.05) . At 1 min post-reperfusion, sTM levels were comparable between groups. In the HMP group, sTM decreased significantly between 1 and 30 min after reperfusion, whereas no change was observed in the SCS group. Between-group differences at either time point did not reach statistical significance. Early renal function parameters improved in both groups, with no significant inter-group differences. No cases of delayed graft function or graft thrombosis occurred. Conclusions: Kidney preservation strategy may modulate very early graft-level endothelial responses during reperfusion, reflected by renal vein sTM dynamics. Although a limited sample size may have reduced the ability to detect between-group differences, very early renal vein sTM measurements may provide insight into ischemia–reperfusion injury. Clinical relevance requires validation in larger studies. Keywords: kidney transplantation; machine perfusion; reperfusion injury; thrombomodulin; endothelial injury; cold ischemia; graft function; biomarkers 1. Introduction Chronic Kidney Disease (CKD) is characterized by a progressive decline in renal function, driven by a cascade of pathological changes [1] . In Poland, an estimated four million people are affected by this condition, many of whom remain unaware until the di

FAQs

Did the study find differences in early graft function between groups?

Early renal function parameters improved in both groups, and no significant inter-group differences were reported. No delayed graft function or graft thrombosis occurred.

Sep 30, 2026

Upload by jayni