The effect of dyes used to evaluate the in situ, ex-vivo, and perfused kidney.

Methylene blue, indigo carmine, and fluorescein dyes were evaluated to determine their effect on the dog kidney. Methylene blue and indigo carmine were administered intravenously and intraarterially to the in situ vascularized kidney and serial histologic appearance of the kidney was determined. The three dyes were administered intraarterially to excised kidneys that were then preserved for 1 hour in the cold and autotransplanted; and finally the three dyes were administered to the perfusate of excised kidneys that were perfused for 18 hours by cryoperfusion with an albumin perfusate and then autotransplanted. Renal function and histology were determined 5 days after autotransplantation. Methylene blue dye did not damage the in situ vascularized kidney as judged by renal histology. However, administration of methylene blue to the ex vivo kidney that was subsequently short term cold stored or perfusion stored was associated with marked apparent ischemic damage of the organ. Indigo carmine dye did not adversely affect either the in situ vascularized kidney or the short term cold stored kidney. However, with perfusion storage, indigo carmine produced apparent vasoconstriction that led to perfusion failure. Fluorescein dye was not harmful to the kidney either during short term cold storage or during perfusion preservation. It is concluded that fluorescein is the dye of choice for evaluating the vascular anatomy or macroperfusion status of the kidney.

Clinical renal preservation by cryoperfusion with an albumin perfusate: renal perfusion with albumin.

Eighty-six human kidneys have been preserved by cryoperfusion with an albumin-based perfusate for five to 50 hours prior to transplantation. Sixty-three of the kidneys were transplanted. The overall immediate function rate was 72% and was 100% (34/34) for kidneys with no warm ischemic damage transplanted into recipients without hypotension or prior sensitivity. The overall actuarial one-month kidney survival rate was 87%, the three-month survival was 73%, and the one-year survival rate was 65%. No kidney was discarded because of poor perfusion. Perfusion data, including flow, dastolic pressure, perfusion time, and lactate concentration were not predictive of immediate renal function. Light, electron, and immunofluorescence microscopic study of biopsy specimens showed no evidence of perfusion or immunologic damage to the kidneys. Perfusion of transplantable kidneys with albumin provides reliable preservation for up to 50 hours without producing either structural or immunologic damage to the organ.

Renal donor pretreatment with cytotoxic agents: immunologically ineffective and damaging to the graft.

Simultaneous double renal allografts were performed in 32 dogs to evaluate the effect of pretreatment of the donor kidney with either Medrol, cytoxan, and methotrexate or medrol and procarbazine. There was no prolongation of survival of treated allografts. Immunosuppressive therapy for the transplanted animal unmasked a pretreatment injury of the pretreated kidney. Treatment of an autograft kidney in an intermediate host produced a cytotoxic tubular lesion in the kidney and also appeared to protect the kidney from the double ischemic insult incurred during the transplantation procedure. Pretreatment of dog donors of renal allografts with cytotoxic agents thereby offers no immunologic advantage for graft survival and produces a cytotoxic tubular lesion that is detrimental to kidney survival when ischemic and immunologic injury is minimal.