Prostaglandin E1 influences pulsatile preservation characteristics and early graft function in expanded criteria donor kidneys.
BACKGROUND
Unlike simple cold storage, machine preservation allows dynamic assessment and manipulation of the donor organ prior to transplantation. We prospectively compared the effects of five pharmacological agents added to the perfusate during machine preservation of expanded criteria donor (ECD) kidneys in order to (1) describe their influence on perfusion parameters and (2) determine their influence on early graft outcome.


METHODS
Two hundred seventy-five consecutive ECD kidneys were preserved in our laboratory between 1/1/94 and 12/31/97 by either machine perfusion (MP) or cold storage (CS). ECD kidneys were defined as those requiring pretransplant biopsy. ECD kidneys were divided by method of preservation and MP kidneys were randomized to receive prostaglandin E1 (MP+PGE1), trifluoperazine (TFP), verapamil (VER), papaverine (PAP), mannitol (MAN), or no intervention during the period of machine perfusion. CS kidneys were randomized to receive PGE1 (CS+PGE1), TFP, VER, PAP, or no intervention. All MP kidneys were preserved by continuous hypothermic pulsatile perfusion using Belzer II solution and perfusion parameters were measured every hour during pulsatile perfusion. All CS kidneys were stored in 1.0 L of University of Wisconsin (UW) solution.


RESULTS
The addition of PGE1 to machine perfusate increased renal flow and decreased renal resistance. Moreover, the MP+PGE1-treated group was associated with improved early graft function compared to all other groups. The addition of VER, TFP, PAP, or MAN influenced neither the perfusion characteristics nor the incidence of early graft function in MP kidneys. Similarly, the addition of VER, TFP, or PAP did not influence early graft function in the CS kidneys. The CS+PGE1 group exhibited a significantly lower incidence of early graft function than did the MP+PGE1 group.


CONCLUSIONS
PGE1 treatment during machine preservation improves hydrostatic perfusion parameters and reduces the incidence of delayed graft function in ECD kidneys. Moreover, the addition of PGE1, TFP, VER, or PAP to UW does not influence early graft function in the CS kidney.
Polyak
M M
MM
Division of Transplantation, The New York Presbyterian Hospital-Cornell Medical Center, New York, New York, 10021, USA.
Arrington
B O
BO
Stubenbord
W T
WT
Kapur
S
S
Kinkhabwala
M
M
D000527:Alprostadil / Q000494:pharmacology*; D002118:Calcium / Q000032:analysis; D015925:Cryopreservation; D006801:Humans; D007668:Kidney / Q000503:physiopathology* / Q000648:ultrastructure; D016030:Kidney Transplantation; D008854:Microscopy, Electron; D008875:Middle Aged; D009926:Organ Preservation / Q000379:methods; D010477:Perfusion / Q000379:methods; D011379:Prognosis; D011446:Prospective Studies; D011673:Pulsatile Flow; D013997:Time Factors
D000527:Alprostadil; D002118:Calcium