RESUMO
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.
Assuntos
Temperatura Baixa , Transplante de Rim , Preservação de Órgãos/métodos , Perfusão/métodos , Preservação de Tecido/métodos , Albuminas , Sobrevivência de Enxerto , Humanos , Rim/patologia , Fatores de Tempo , Transplante HomólogoRESUMO
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.
