Preimplantation Evaluation of Renal Transplant Donor Kidneys

Abstract

Between 1973 and 1977, 70 cadaver kidney transplants were performed at Henry Ford Hospital [1]. Cadaver donors remain the largest source of available kidneys for patients with end-stage renal disease [2,3]. Donor kidneys may arrive at the transplant center in a variety of containers [4] and often without information about the time of death of the donor and the time of surgical removal of the kidneys [5]. Development of pulsatile perfusion units [6] has been helpful, but evaluation of transported cadaver doners is still largely limited to a subjective inspection of the kidney. We have developed a simple, objective means for preimplantation assessment of donor kidneys. Such a test can provide objective criteria by means of which we can establish the viability of transported kidneys. Our results to date extend previous work by one of the authors [7] and others [8,9] and have been obtained in experimentally damaged kidneys in dogs. Warm ischemia times in excess of 15 min may result in an increased incidence of acute tubular necrosis [10]; if identified, severely damaged kidneys can be removed from the donor pool. This would reduce the morbidity and mortality associated with unsuccessful transplantation of nonviable kidneys.