title: The hazards of basing acceptance of cadaveric renal allografts on pulsatile perfusion parameters alone.
abstract: BACKGROUND
  Pulsatile perfusion (PP) is used by some centers to provide information that may aid in the selection of cadaveric renal allografts for transplantation. However, basing organ acceptance on PP parameters alone may lead to the discarding of kidneys from otherwise suitable donors. In this case series, we report the reevaluation and transplantation of kidneys refused by other centers after evaluation with PP.
  
  
  METHODS
  Retrospective review of 14 cadaveric kidneys imported for repeat PP at our center after initially poor PP parameters from an outside organ procurement organization resulted in refusal by multiple centers.
  
  
  RESULTS
  Median age of donors was 46 (range 21-64), and mean terminal serum creatinine was 1.3+/-0.6 mg/dL. Despite favorable donor characteristics, each kidney was refused by an average of 9.3 centers. Poor PP parameters and concerns about donor quality were the reasons for refusal in the majority of cases. Pulsatile-perfusion parameters at the outside center were poor: mean flow of 103 mL/min/100 g and mean resistance of 0.321 mm Hg/(mL/min/100 g). Repeat PP parameters at our center after importation were markedly improved (flow=167 mL/min/100 g and resistance=0.195 mm Hg/[mL/min/100 g]). Eleven of 14 kidneys were transplanted and currently have acceptable graft function (mean serum creatinine=1.6 mg/dL at a median follow-up of 12 months).
  
  
  CONCLUSIONS
  This series describes the successful transplantation of 11 kidneys from acceptable donors that were initially discarded by multiple centers after poor PP parameters were obtained. The good allograft function in these organs emphasizes the importance of considering all donor factors when making allocation decisions.
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Sonnenday
authors.forename: Matthew
authors.initials: M
authors.lastname: Cooper
authors.forename: Edward
authors.initials: E
authors.lastname: Kraus
authors.forename: Fred
authors.initials: F
authors.lastname: Gage
authors.forename: Christopher
authors.initials: C
authors.lastname: Handley
authors.forename: Robert A
authors.initials: RA
authors.lastname: Montgomery
mesh_terms: D000328:Adult; D002102:Cadaver; D003404:Creatinine / Q000097:blood; D006801:Humans; D007668:Kidney / Q000098:blood supply; D016030:Kidney Transplantation / Q000502:physiology*; D008875:Middle Aged; D009926:Organ Preservation / Q000379:methods; D018579:Patient Selection; D010477:Perfusion; D012079:Renal Circulation; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014019:Tissue Donors / Q000706:statistics & numerical data; D014184:Transplantation, Homologous; D014655:Vascular Resistance
chemical_list: D003404:Creatinine