Kidney preservation by hypothermic perfusion with albumin versus plasma and with pulsatile versus non-pulsatile flow.

Abstract

Abstract Four groups of canine kidneys were preserved by hypothermic perfusion for 24 hours in an attempt to compare the relative merits of using cryoprecipitated plasma or albumin as perfusates and of using pulsatile or non-pulsatile flow. All the kidneys were subsequently autotransplanted At 0, 3 and 24 hours during preservation the following parameters were measured: perfusate and urine flow, renal vascular resistance, perfusate serum glutamic oxaloacetic transamianase, lactic dehydrogenase, acid and alkaline phosphatases, ammonia, free fatty acids, clearances of creatinine, 131I hippuran, Na+ and K+. After reimplantation similar renal clearance studies were carried out. After transplantation overall kidney viability was assessed by recipient survival and by serum creatinine levels. The results obtained were subjected to statistical analysis and compared between the groups. It was found that perfusion with albumin solution gave a significantly higher perfusate flow rate (P<0·02) and lower vascular resistance (P< 0·001) than perfusion with plasma. With albumin as the perfusate there was no significant difference in perfusion characteristics or in the post-implantation renal clearances regardless of whether pulsatile or non-pulsatile flow was used. With plasma as the perfusate there was significantly higher perfusate flow (P<0·01), lower vascular resistance and higher post-implantation creatinine and hippuran clearances (P<0·02, P<0·001) with pulsatile than with non-pulsatile flow. In 24-hour renal preservation overall recipient survival and graft function after transplantation were similar regardless of the nature of the perfusate or the type of perfusion.