TRANSPLANTATION STUDIES OF STORED KIDNEY

Abstract

1. Renal preservation has been an important problem in performing renal transplantation. In this paper, transplantation studies of stored kidney are presented
2. Using 10 adult mongrel dogs, basic experiments were carried out to determine the optimal storage solution, temperature and method from histological findings.
1) Solution A (500ml of 5% dextrose with 10% low molecular weight dextran, 2% procaine 50ml, heparin 15 mg and tetracycline 250mg) was found to be less harmful and revealed better preserving effect than the solution B (physiologic saline 500ml, 2% procaine 50ml, heparin 15 mg and tetracycline 250mg). 2) Simple immersion into solution A or B was apparently superior to the perfusion technique with the same solution at the same temperature. 3) Storage in a refrigerator at 0 to 4°C significantly reduced renal damage resulting from periods of ischemia. 4) The preservation of a kidney would be best accomplished by immersing it in a solution A at temperature 0 to 4°C, however, even with this method, the permissible length of storage seemed to be limited within 10 to 24 hours. 5) Microscopic sections of renal tissue stored by this technique revealed that the glomeruli were safely preserved for 12 hours while tubuli had developed hydropic degeneration in one hour, vacuolation in 2 hours and localized necrotic change in 10 to 12 hours.
3. Twenty autotransplantation experiments were carried out on adult mongrel dogs.
1) The kidneys were immersed in the above mentioned storage method for 30 minutes to 24 hours and then brought out for autotransplantation. 2) Fourteen of the 20 autotransplanted kidneys exhibited mechanical failure and postoperative accident. Six dogs (1 animal with 2 hours, 1 with 4 hours, 3 with 10 hours and 1 with 24 hours storing) were alive and well for periods of 150 to 690 days after removal of the contralateral kidneys in 3 to 5 weeks after autotransplantation. 3) The autotransplanted kidneys which were preserved for 10 and 24 hours started to secrete within 5 to 10 minutes of establishing the new circulation. 4) With 24 hours preservation, the transplanted kidney was known to be functioning by aortography and intravenous pyelography on the 7th postoperative day, as well as the group which were preserved 10 hours on the 6th day. 5) At 3 months and one year postoperatively, their blood urea nitrogen levels ranged between 20 and 47.5mg/dl, and serum electrolytes, urinalyses, urinary concentration tests, PSP tests, radioisotope renograms and systolic blood pressures were within almost normal limits. 6) With 10 hours immersion, biopsy specimens, obtained one week and 3 months after the transplantation, not only revealed good functioning kidney but demonstrated almost normal histologic patterns. However, with 24 hours, the histological finding of the biopsied specimen, obtained 3 months after the autotransplantation, showed slight chronic inflammatory changes.