Kidney blood flow and microcirculatory changes after autologous kidney transplantation

Abstract

The problem of the non-viable renal transplant has not yet been solved. In the renal transplantation centre in Freiburg we observed 12 kidneys which remained functionless in a series of 300 renal transplants. Shock in the donor prior to removal of the kidney, prolonged warm ischaemia, and perfusion damage (in addition to rejection) are considered to be probable causes. On the other hand, little is known about the deleterious effect of a fall in blood pressure in the recipient during the revascularization phase, yet in our patients the systolic blood pressure during the critical phase of revascularization varied between 70 and 100 mmHg over a period of approximately 45 min. The cause of this was that our patients had been dialysed immediately prior to transplantation, resulting in a latent hypovolaemia. The hypothesis that hypotension might be the cause of transplant failure was supported by the fact that in 8 of the 12 donors the other kidney functioned well after transplantation.