STUDY ON KIDNEY PRESERVATION FOR TRANSPLANTATION

II. In Mortuo Renal Preservation

Abstract

For the successful cadaver kidney transplantation, it is necessary to preserve cadaver kidney by a simple atraumatic method until consent for removal of kidney from the family is obtained. For this purpose three simple methods of 4 hour cadaver kidney preservation, to be described below, were studied in dogs.
a). b). Selective (a) continuous, b) intermittent) in situ hypothermic perfusion methods: After sacrificing a dog, a two-balloon catheter was retrogradely inserted into the aorta, and two balloons were positioned just above and below the renal arteries. After inflating balloons the kidneys were perfused regionally with hypothermic perfusate for 4 hours through holes located between two balloons. Venous outflow was done by gravity drainage. c). pararenal cooling method: After sacrificing a dog, a cooling fluid (0°C saline) was infused into both peritoneal and retroperitoneal space, and the peritoneal cooling fluid was changed hourly. Kidneys were preserved 4 hours by this cooling method.
Results
1. The temperature dropped below 15°C in 30 minutes in the kidney preserved by the continuous perfusion method. In the intermittently perfused kidney, the temperature was lowered to below 15°C after 15-30 minutes and they were maintained between 10-15°C thereafter. The pararenal cooling lowered the temparature below 15°C in 30 minutes and kept it between 15-20°C thereafter.
2. All the kidneys preserved for 4 hours by any of the above three methods, showed adequate by T. T. B. viability test and excreted urine promptly after establishment of renal blood flow.
3. In the kidneys preserved for 4 hours by any method, no distinct histological change from the normal was demonstrated under the light microscopy. Electromicroscopically the change of proximal tubules (mitochondria, microvilli) was even more obscure than that in the kidney an hour post mortem, which is generally believed to be reversible. The expansion of intercellular space became progressivelly less distinct in the continuous (a), intermittent perfusion (b) and pararenal cooling (c).
4. The pararenal cooling preservation appears to be the simplest and most useful one, although all three methods are practically applicable to the renal transplantation.