Gravity perfusion versus high-pressure perfusion in kidney transplantation: results from a prospective randomized study

Abstract

HE VIABILITY of a kidney graft depends on several factors that can be classified as donor-dependent (DDF), recipient-dependent (RDF), or iatrogenic (IF). Among the latter, we distinguish six variables: therapy; surgical technique; preservation method; perfusion solution; type of perfusion; and perfusion technique. Several studies have focused on DDF, RDF, and some iatrogenic factors, but little is known about the effects of perfusion techniques and flow rate on organ viability in the clinical field. During donor operation, the in situ kidney is commonly perfused by a gravity-hydrostatic pressure of 75 to 100 cm H2O (gravity perfusion [GP]). In recent years, some investigators have advocated an apparently more physiologic technique in which perfusion solution is flushed under an additional pressure of 100 mm Hg (high-pressure perfusion [HPP]). The rationale is to create a mean pressure similar to that present in the arterial system in normal conditions, with the aim to perfuse better the small parenchymal vessels. This prospective randomized study was carried out to compare GP vs HPP in terms of outcome on early graft function after kidney transplantation.