N.A. Halasz

The effects of oxygen free radicals on the preserved kidney

This study evaluated the effect of specific scavengers of oxygen derived free radicals on the results of kidney preservation. The immediate function of rabbit kidneys preserved for 24 hr by hypothermic perfusion was studied on an ex vivo shunt. A significant improvement in creatinine clearance was seen when the perfusate was treated with superoxide dismutase (SOD) and catalase (CAT), with values of 261 +/- 82 ml/hr vs control values of 203 +/- 72 ml/hr, P less than 0.05. This effect was enhanced if a long-persistent polyethylene glycol-linked form of SOD, namely PEG-SOD, was used (330 +/- 58 ml/hr, P less than 0.01). Recipient treatment and other modifications designed to protect against free radicals resulted in similar improvement in function. In contrast, no effect of free radical scavengers could be demonstrated in kidneys which were preserved by flush cooling, whether the agents were added to the flushing solution, given to the recipient, or both.

Acute pancreatitis following renal allotransplantation. A lethal complication.

Since first described by Starzl in 1964 (1), acute pancreatitis following renal homotransplantation has been the subject of sporadic reports and reviews (2–5). The generally reported incidence has been around 2%, with a mortality rate of 50–60%. A recent experience with such a patient caused us to retrospectively analyze our own series of renal transplant recipients. In an eight-year period, there were six patients who had documented pancreatitis out of a total 120 renal homograft recipients, an incidence of 5%. The mortality was distressingly high; five out of the six succumbed directly to this complication, a rate of 83%. The purpose of this paper is to review these six patients in detail, with special attention to the protean etiologies and manifestations of this lethal complication.

Importance of anion content and osmolarity in flush solutions for 48 to 72 hr hypothermic kidney storage

Abstract Some new formulations of the “intracellular” flush solution for hypothermic kidney storage have been characterized by increased osmolarity and the use of anions other than phosphate. The influence of these factors has been investigated in a 48- and 72-hr canine kidney preservation model. Neither substitution of citrate or sulphate for phosphate nor increase of the osmolarity of the C 2 solution improved the results.

Optimal redox electrode potential for 24-hour rabbit kidney perfusion.

This study was conducted to determine whether an optimum redox electrode potential existed for 24-hr hypothermic perfusion of rabbit kidneys. The perfusate consisted of a Ringers-albumin solution to which was added varying amounts of the reducing agents, glutathione and ascorbate, either individually or in equimolar amounts. Electrode potential was monitored with a vitreous carbon electrode in relation to a silver-silver chloride reference cell, and kidney function was measured after preservation by connection to the circulation of a perfusor animal via a shunt. The best results were obtained using equimolar amounts of the reducing agents. Under these circumstances a definite optimum range for perfusate electrode potential was identified (Es = 40-70 mV) within which renal function was indistinguishable from unpreserved controls. Higher and lower perfusate electrode potentials were associated with significantly lower creatinine clearances. However, the explanation for these results appeared to be more complex than redox control alone, since kidney function was dependent not only on the redox potential of the perfusate but also on the reducing agents with which the adjustment had been made. Ascorbate proved to be significantly better than glutathione within the optimum potential range.

The effect of hyperbaria on the glycerolization of the canine kidney

Summary Thirty-seven dog kidneys were perfused extracorporeally with varying concentrations of glycerol, using 3 atm of hyperbaric oxygen and helium to attempt reduction of organ edema and osmotic damage. Measurement of renal vein blood flow and reimplantation showed no beneficial effect. Sequential osmolarity measurements of renal vein effluent demonstrated that hyperbaria did not adversely affect equilibration of glycerol between renal cells and perfusate.

Evaluation of perfusion techniques in renal preservation

Abstract One hundred kidneys were perfused, with and without pulsatile flow, at various flow rates, pressures, and pH values, with a dextran-electrolyte solution for 4 hr and studied during and after preservation. The best results were obtained using flow-controlled, nonpulsatile perfusion, performed at an alkaline pH. Viability may be predicted by renal blood flow, perfusion pressure, weight gain, and several enzymes.