The usefulness of initial brief pulsatile perfusion in extending the applicability of cold storage for renal transplantation - A preliminary report

Sharing of cold stored (CS) kidneys is hampered by the time limitations of cold storage. Delayed graft function is commonly associated with CS preservation beyond 24 hours and is of particular concern in hyperimmunized recipients, where the graft survival of damaged kidneys transplanted is particularly poor. In contrast to CS preservation, pulsatile perfusion (PP) preservation has been shown to permit a longer preservation time, with favorable effects in the need for national organ sharing. The technology of PP preservation, however, is excessively labor intensive, and transportation of kidneys is logistically difficult. In an attempt to simplify this system, a canine model was developed to permit a brief period of PP (four hours) at the time of organ retrieval, followed by simple cold storage subsequently. The results indicate that a brief four-hour period of PP permits safe cold storage of canine kidneys for as long as 48 hours thereafter, with good renal function after retransplantation. The data suggest, in addition, that some organs procured from non-heart-beating cadaver donors may also be salvaged and transplanted successfully by this combined short PP-CS method.