Initial Studies of Isolated Kidney Perfusion

Angiographic and gravametric studies of dog kidneys perfused with electrolyte, Dextran, or albumin solution are presented to demonstrate the possibility of extending organ preservation for transplantation without loss of function. Findings include a reduction in flow and weight gain with the nonprotein solutions and maintenance of flow with albumin solution. Gross changes of the perfused kidneys are also described

Use of a Cooling Jacket During Kidney Transplantation

The model of renal autotransplantation, with immediate contralateral nephrectomy in the dog, is used to demonstrate that continuous cooling by means of a cooling jacket during vascular anastomoses is effective in preserving renal function acutely and over a two-month follow-up period

Prolonging oxygen consumption during preservation of canine kidneys by the addition of continuous dialysis

Kidneys were preserved by continuous pulsatile perfusion and their metabolic rate monitored by O2 consumption. Experiments were carried out to determine if dialyzing the perfusate to supply metabolic substrates would aid in kidney preservation. A control group was compared against two experimental groups at 25°C. Average preservation time before fall off of oxygen consumption differed for each group: control - 8 hours, dialysis with amino acids - 6 hours, dialysis with amino acids and cofactors - 11 hours. Results indicated that, if suitable concentrations of metabolic substrates and cofactors were used, the preserved kidneys maintained higher levels of O2 consumption for longer periods of time

Effect of Donor Pretreatment on the Graft Survival of Human Cadaver Kidneys

The effect of donor pretreatment on perfused cadaver kidney allografts was evaluated in 40 recipients at Henry Ford Hospital over a two-year period. Ofthe 40,23 received kidneys from donors pretreated with 40 mg/K each of cyclophosphamide and methylprednisolone during the first year of the study and up to 70 mg/K during the second year. Our results indicated that donor pretreatment for five to eight hours did not consistently improve survival rates in pretreated perfused cadaver kidneys following transplantation. The use of cyclophosphamide for donor pretreatment does not prevent the use of continuous perfusion to preserve human kidneys. Dosages up to 70 mg/K may be used without an apparent increase in acute tubular necrosis or significant early loss of renal function

Effect of Acute Posttransplant Renal Failure on the Survival of Perfused Cadaver Kidneys

Between 7973 and 7977 we encountered 22 cases of acute renal failure after transplantation in 70 patients who received perfused cadaver kidneys. Nearly two-thirds of 76 nonfunctioning grafts were lost due to subsequent superimposed rejection, often undetected and, hence, untreated. Thirty-one percent of the 76 recovered function. The recovery rate, we believe, can be improved by earlier diagnosis and treatment of rejection and by avoiding invasive diagnostic procedures in the early postoperative period. If the oliguric period extends beyond two weeks, a closed percutaneous renal biopsy is justified. The diagnosis of rejection and/or other abnormality as well as subsequent treatment are very important in these patients

A Comparison of Kidney Preservation Methods by Oxidative Phosphorylation Studies

An oxygen consumption assay using adenosine diphosphonucleotide (ADP) was performed on canine kidneys to measure the efficiency of oxidative phosphorylation. The purpose of the assay was to establish a respiratory control index (RCI) that could be used to evaluate kidneys preserved by different methods. Of the four methods tested, perfusion yielded the best results after 24-hour preservation. Additionally, four pairs of human cadaver kidneys were evaluated with the same assay. Some correlation existed between the RCI values of the nontransplanted kidney in each pair and the clinical viability of its transplanted mate

Expanded Polytetrafluoroethylene (PTFE) and External Velour Grafts as Small Artery Substitutes in Dogs

This experimental study compared the clinical patency, angiographic appearance, and histology of 4 mm polytetrafluoroethylene (PTFE) and external double velour grafts which were used as external iliac artery substitutes in dogs. At one week there were no significant differences. However, at two months, none of the PTFE grafts were open, whereas six of the seven external double velour grafts were patent (p\u3c0.05). Thus, in this study the 4 mm PTFE grafts are poor substitutes for canine iliac replacement

Length of Perfusion Time in Cadaver Kidney Transplantation

The results of transplantation survival for 70 consecutive cadaver kidneys preserved under hypothermic pulsatile perfusion at Henry Ford Hospital are reviewed. Pulsatile perfusion for up to 30 hours did not adversely alter the survival rate following transplantation. Thus, kidneys perfused for prolonged periods of time (\u3e 20 hours) can be used for transplantation, if the basic rules for organ retrieval and preservation have been followed. Hypothermic pulsatile perfusion of cadaver kidneys has been demonstrated to be an adequate system for ex-vivo preservation for transplantation