Kidney preservation

Abstract

The evolution of clinical organ transplantation over the past 25 years has had a major influence on the methods used for kidney preservation. The work of Belzer and his colleagues [1] and that of Collins et al. [2] provided the foundation for the two alternative methods of continuous hypothermic perfusion or initial flushing followed by ice storage. For some years the processes of cadaver donor maintenance, organ procurement, and preservation were focused solely on the needs of the kidney. Donors were vigorously fluid-loaded, usually without regard for the effect on the heart, lungs or other abdominal organs. Kidneys were often dissected and removed individually, and in most cases were flushed with Collins’ solution and stored on ice until transplanted. A minority of centres used continuous hypothermic perfusion. Those using perfusion claimed better immediate function, while advocates of simple flushing justified their choice in terms of lower cost, greater simplicity and essentially equivalent results [3]. The discovery of cyclosporine, and its introduction into general clinical use in 1984 changed the picture substantially. While in earlier years it was the exception to procure thoracic and extrarenal abdominal organs along with the kidneys, this is now the rule. As a result, the emphasis in donor management, organ procurement and preservation methods has shifted to the needs of the heart, lungs and the extrarenal abdominal organs. Donor hydration is now practised conservatively to avoid inducing pulmonary or visceral oedema. The abdominal organs are usually procured en bloc, and preservation methods are chosen with the liver and pancreas primarily in mind.