Improved outcomes in cadaveric renal allografts with pulsatile preservation.
BACKGROUND
Early immunologic and non-immunologic injury of renal allografts adversely affects long-term graft survival. Some degree of preservation injury is inevitable in cadaveric renal transplantation, and, with the reduction in early acute rejection, this non-immunologic injury has assumed a greater relative importance. Optimal graft preservation will maximize the chances of early graft function and long-term graft survival, but the best method of preservation pulsatile perfusion (PP) versus cold storage (CS) is debated.


METHODS
Primary cadaveric kidney recipients from January 1990 through December 1995 were evaluated. The effects of implantation warm ischemic time (WIT) ( < or = 20 min, 21-40 min, or > 40 min) and total ischemic time (TIT) ( < or > or = 20 h) on death-censored graft survival were compared between kidneys preserved by PP versus those preserved by CS. The effect of preservation method on delayed graft function (DGF) was also examined.


RESULTS
There were 568 PP kidneys and 268 CS kidneys. Overall death-censored graft survival was not significantly different between groups, despite worse donor and recipient characteristics in the PP group. CS kidneys with an implantation WIT > 40 min had worse graft survival than those with < 40 min (p = 0.0004). Survival of PP kidneys and those transplanted into 2 DR-matched recipients was not affected by longer implantation WIT. Longer TIT did not impact survival. DGF was more likely after CS preservation (20.2% versus 8.8%, p = 0.001).


CONCLUSIONS
Preservation with PP improves early graft function and lessens the adverse effect of increased warm ischemia in cadaveric renal transplantation. This method is likely associated with less preservation injury and/or increases the threshold for injury from other sources and is superior to CS.
Sellers
M T
MT
Department of Surgery, University of Alabama School of Medicine, Birmingham 35294, USA.
Gallichio
M H
MH
Hudson
S L
SL
Young
C J
CJ
Bynon
J S
JS
Eckhoff
D E
DE
Deierhoi
M H
MH
Diethelm
A G
AG
Thompson
J A
JA
D000241:Adenosine; D000328:Adult; D000493:Allopurinol; D002102:Cadaver; D002314:Cardioplegic Solutions; D003080:Cold Temperature; D005500:Follow-Up Studies; D005978:Glutathione; D006085:Graft Survival; D006801:Humans; D007328:Insulin; D016030:Kidney Transplantation; D009926:Organ Preservation / Q000379:methods*; D019188:Organ Preservation Solutions; D011673:Pulsatile Flow; D011887:Raffinose
D002314:Cardioplegic Solutions; D007328:Insulin; D019188:Organ Preservation Solutions; C055206:University of Wisconsin-lactobionate solution; D000493:Allopurinol; D005978:Glutathione; D000241:Adenosine; D011887:Raffinose