Hypertonic Citrate Solution Research Articles

Studies of renal preservation using a rat kidney transplant model. Evaluation of citrate flushing.

Rat kidneys were flushed with isotonic citrate solution, hypertonic citrate solution, or Collins's C2 solution, and were stored hypothermically for 24 hr before transplantation into another rat of the same inbred colony. The number of animals surviving for one month was greatest with isotonic-citrate-flushed kidneys (82%), and least with Collins's C2 solution (27%). Functional and morphological damage after transplantation was consistently greater in Collins's-flushed grafts, as compared with citrate-flushed grafts. Best results were attained with the isotonic-citrate flushed grafts. Seven days after contralateral nephrectomy all surviving animals had elevated serum creatinine and urea concentrations, along with decreased creatinine clearance, and they had secreted large volumes of dilute urine. Renal function was best in animals with isotonic-citrate-flushed grafts. After one month, significant improvement in urine osmolality, creatinine clearance, and serum creatinine had occurred only in the rats with citrate-flushed grafts. There were no significant differences between the citrate groups. All surviving rats had some residual renal cortical damage, but severe interstitial nephritis (greater than 30%) was much less frequent in the citrate groups.

Failure of hypertonic citrate solution to preserve canine renal transplants after 24 hours of hypothermic storage.

Department of Surgery Section of Transplantation and Surgical Research Henry Ford Hospital Detroit, Michigan 48202 Department of Surgery University of Minnesota Minneapolis, Minnesota

Preservation of ischaemically injured canine kidneys with hypertonic citrate solution: the importance of mannitol.

The ability of hypertonic citrate solution to preserve ischaemically injured canine kidneys was investigated. It was found that if mannitol was given i.v. before ischaemia and again after graft revascularization, kidneys subjected to 30 min of warm ischaemia could be preserved for 24 hr, maintaining immediate life-sustaining function.

Evaluation of renal preservation using the isolated perfused rat kidney. Ischaemic damage and the effects of inosine.

An isolated perfused rat kidney has been used to determine the response to prolonged warm ischaemia and to examine renal preservation procedures. All measurements of function declined to near zero after 90 min of warm ischaemia. Measurement of total sodium reabsorption (TNa) was the most sensitive indicator of renal damage. Inosine was without effect on subsequent renal function after 60 or 90 min of warm ischaemia, or after 24 hr of cold ischaemia. Surface cooling or hypertonic citrate solution, in the cold or at 37 degrees C, significantly improved renal function, and their use in clinical renal preservation rather than that of inosine was supported by the present results.

PRESERVATION OF CADAVER RENAL ALLOGRAFTS: COMPARISON OF ICE STORAGE AND MACHINE PERFUSION

Preservation of cadaveric renal allografts by ice storage and by machine perfusion after a preliminary flush with a hypertonic citrate solution has been compared in a prospective clinical trial between matched pairs of kidneys from the same cadaver donor. Over a two-year period, ice storage after flushing with the new solution gave results comparable with machine perfusion. Times of warm ischaemia and total times of storage were similar in ice-stored and machine-perfused kidneys and averaged about 16 hours. In each group of recipients, more than half of the kidneys had good early function and one-year survival times were also similar.