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Organ transplantation is a race against time

There are never enough donor organs. The organs that are available must be transplanted as quickly as possible. Medicine is therefore fully committed to keeping organs healthy for longer. Marlon de Haan is researching at the Leiden University Medical Center (LUMC) how you can keep kidneys alive outside the body.

Organ transplantation is a race against time. An organ must be transplanted within 24 hours. It must be removed from the donor, transported, checked and placed with the recipient. Marlon de Haan is researching how you can extend this period for kidneys. ‘An organ is, as it were, an organism, with individual cells that all have their own energy needs,’ he explains. ‘Until now, we have reduced the energy requirement of a donor organ by storing it on ice. Cooling slows down the metabolism.’

For his PhD, De Haan is researching an alternative way of storing kidneys. Instead of being cooled, the kidney is kept in a perfusion system. ‘That is a kind of pump that can supply the organ with nutrients. By adding oxygen, sugar and protein to the kidney, we try to keep the organ alive for longer – and ultimately have more time for a transplant. It has already been possible to extend the lifespan of a pig kidney in the lab, but also of a human kidney that was rejected for transplantation. That worked for up to four days. The first important step has therefore been taken.’

More time is not the only benefit. ‘If there is any doubt about the quality of a donor organ, it will not be used’, explains De Haan. ‘But in a perfusion system, the functioning of an organ can be monitored for a longer period of time. If the initial doubts have been removed and the organ appears to be functioning properly, it can still be transplanted. In addition, it is possible to condition an organ in the perfusion system. By making small adjustments, the organ can be made more suitable for a specific recipient. This reduces the risk of rejection.’

Pork kidney
Storage and conditioning are already very successful in some organs, such as the liver. For the kidney, however, it is still music in the future. ‘The kidney is one of the most complex organs in the body,’ explains De Haan. ‘That’s because a kidney consists of almost thirty types of cells. For comparison, a heart has about ten. Not only do all those cells have their specific energy needs, it is also important how they work together. We are trying to find out by experimenting with pig kidneys.’

Pig kidneys are often used for medical research because they are very similar in size, structure and appearance to human organs; also on a cellular level. De Haan and his colleagues will collect the kidneys from the slaughterhouse themselves. “The situation should resemble the reality of a transplant,” he says. ‘That is why the organs are quickly removed after slaughter and transported on ice. We’ll go straight to the lab and get to work.’

Internships
De Haan finds it difficult to say where his fascination for organs comes from. “I think a high school biology teacher inspired me. She made sure that I could spend a day at Erasmus MC in the heart department. Later I made my profile piece about the heart. My bachelor’s research was also about the heart, namely the idea of ​​making a contractile heart tube.’

De Haan will have obtained his PhD rather than graduated, because his internships came to a standstill due to corona. On the other hand, he had room to participate in this research project. “When you start this, you know you can’t stay to the end,” he says. ‘Only when the application can be used on patients will the research be successful. You can’t do that within a four-year PhD. I do hope to remain indirectly involved in this research in addition to my internships. And maybe I’ll return after graduation; it just depends on how well you like clinical medicine.’

Bron: LUMC / Wilke Martens

Researchers calculated the difference between the estimated age and the actual age

There is a link between how old someone looks and age-related health problems, including cognitive decline. This is the conclusion of new research in which scientists from Erasmus MC participated. “It seems that aging of the body and mind is reflected in the face.”

2679 men and women from the ERGO study participated in the study, a large cohort study in which the health of thousands of residents of the Ommoord district of Rotterdam is monitored. Their median age was 65.8 years. The study is published in British Journal of Dermatology.

Face photos were taken of each person, from the front and from the side, without make-up, creams and jewellery. An independent panel estimated the age of each of the participants from these photos, with no other information. Each photo was rated by an average of 27 panelists.

Age score
The researchers calculated the difference between the estimated age and the actual age. They put a score on that. The higher the perceived score, the younger the person looks for their age. The researchers – Unilever Research and Development was involved in addition to Erasmus MC – then linked the age score to the participants’ lifestyle and health data to see if there were any links with ageing-related diseases.

Lifestyle factors adjusted for in the analyzes included BMI, exposure to ultraviolet light (UV), smoking behavior and ‘pack years’ – how many people have smoked over time. The health data includes kidney disease, cardiovascular and lung disease. They also looked at musculoskeletal disorders, eye disorders, age-related hearing loss and the degree of cognitive impairment, adjusted for educational level.

Facial fat
The youngest-looking group was estimated to be an average of five years younger than their actual age and was predominantly male (61%). This group smoked less often and had the highest BMI. The effect of facial fat, which tends to fill wrinkles, probably counted here.

The scientists found an association between a young estimated appearance and higher cognitive function plus a lower risk of chronic obstructive pulmonary disease (COPD), even after adjusting for smoking status and pack years. There was also an association between a young appearance and a lesser degree of osteoporosis, cataracts and age-related hearing loss. No association was found between a young estimated appearance and osteoarthritis, age-related macular degeneration (AMD) or glaucomatous visual field loss (GVFL).

Reflection
Dermatologist Prof. Tamar Nijsten of Erasmus MC, author of the study: ‘A younger estimated appearance seems to reflect the health of your organ systems, body and mind.’

He considers it plausible that the factors responsible for facial aging also affect tissues in other parts of the body. ‘We did not investigate the causes in this exploratory study, but it seems that processes that are partly responsible for skin aging, such as a decrease in collagen and elastin production in the skin, take place in a similar way in other parts of the body. Or that there are other lifestyle factors that affect both the skin and other organs.’

Nijsten continues: ‘This is probably the best study to date that shows that how old you look on your face also reflects aging inside your body. The study clearly shows that something is going on, probably on a biological level and apart from the usual lifestyle factors such as exposure to UV radiation or smoking.’

Snapshot
Nijsten does warn of limitations of the study. ‘The study is a snapshot in time and must be followed up. Moreover, the participant cohort in the ERGO study mainly consists of people with a North-Western European background. Future research could investigate whether the findings of this study also apply to other population groups.’