The influence of periarterial papaverine application on intraoperative renal function and blood flow during laparoscopic donor nephrectomy in a pig model.
BACKGROUND
The transplantation of live donor kidneys harvested laparoscopically is associated with a higher incidence of delayed graft function than the transplantation of grafts harvested via the open technique. The delay is believed to be due to a decrease in renal blood flow during laparoscopic donor nephrectomy (LDN). The aim of this study was to evaluate whether renal function and blood perfusion can be enhanced by the periarterial application of papaverine during LDN.


METHODS
Renal function and blood flow were studied in a porcine model that included a total of 24 pigs (20-30 kg). In 12 of the pigs, urine output and creatinine clearance were determined as measures of renal function. In the other 12 pigs, renal blood flow was determined using fluorescent-labeled microspheres. In each group, the pigs were randomized into two subgroups, one with and one without a perivascular injection of 50 mg papaverine.


RESULTS
As compared to the controls, the animals receiving papaverine had a significantly higher urine output (3.1 +/- 1.6 vs 0.9 +/- 0.45 ml/h/kg; p = 0.02), superior creatinine clearance (2.22 +/- 0.5 vs 0.95 +/- 0.1 ml/min/kg; p = 0.038), and enhanced renal blood flow (4.9 +/- 2.2 vs 2.1 +/- 0.8 ml/min/g; p = 0.008).


CONCLUSIONS
When applied to the tissue surrounding the renal artery, papaverine substantially improves renal function and blood flow during laparoscopic live kidney donation. Whether graft optimization during kidney procurement also translates into improved posttransplantation function remains to be established.
Zacherl
J
J
Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, 81675 Munich, Germany. johannes.zacherl@akh-wien.ac.at
Thein
E
E
Stangl
M
M
Feussner
H
H
Bock
S
S
Mittlböck
M
M
Erhardt
W
W
Siewert
J R
JR
D000818:Animals; D003404:Creatinine / Q000097:blood; D004231:Diuresis / Q000187:drug effects; D004353:Drug Evaluation, Preclinical; D005456:Fluorescent Dyes; D007267:Injections; D007511:Ischemia / Q000517:prevention & control; D007668:Kidney / Q000098:blood supply / Q000187:drug effects* / Q000502:physiology; D016030:Kidney Transplantation; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008863:Microspheres; D023421:Models, Animal; D009392:Nephrectomy / Q000379:methods*; D010208:Papaverine / Q000008:administration & dosage / Q000494:pharmacology*; D011897:Random Allocation; D012077:Renal Artery; D012079:Renal Circulation / Q000187:drug effects*; D013552:Swine; D020858:Tissue and Organ Harvesting / Q000379:methods*; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000494:pharmacology*
D005456:Fluorescent Dyes; D014665:Vasodilator Agents; D003404:Creatinine; D010208:Papaverine