Histologic changes in preserved cadaveric renal transplants

The histologic changes in human cadaveric kidneys preserved by either simple hypothermia or continuous pulsatile perfusion were studied by light and electron microscopy and by immunofluorescence in biopsies obtained immediately before (15 kidneys) and approximately 1 hr after (41 kidneys) transplantation. The changes observed in pretransplantation biopsies were largely similar in kidneys preserved by either method with the exception that foreign material was found in the vasculature of perfused kidneys only. Endothelial edema was more frequent and more severe in nonperfused kidneys. In the 1 hr posttransplantation biopsies, a lesion resembling intravascular coagulation (IVC) was noted in 18 of the 25 perfused kidneys but was absent from all 16 nonperfused kidneys. Transplants with severe IVC lesions failed to function and had extensive cortical necrosis when removed by the end of the first mth. In follow-up biopsies, milder lesions appeared to heal fast and were compatible with transplant function. The IVC lesion is probably due to endothelial cell damage during perfusion of the kidneys.