Perfusion Nephropathy in Human Transplants

To determine whether perfusion preservation affected the structure and survival of kidney transplants, we correlated clinical and histologic data in 77 kidneys biopsied one hour after transplantation. Twenty-one of 36 perfusion-preserved kidneys had a glomerular capillary lesion suggestive of intravascular coagulation. None of 41 kidneys preserved by hypothermia alone had this lesion. Presence of the lesion did not correlate with donor or recipient characteristics, warm or cold ischemia time, H.L.A. match, percentage of preformed lymphocytotoxic antibody titers or perfusion characteristics. Of 21 transplants with the lesion, nine required nephrectomy by one month, and one-month serum creatinine was less than 2.0 mg per deciliter in only three of the remaining 12 transplants. We conclude that perfusion preservation may cause pathologic changes that may adversely affect kidney-transplant function. The causes of the pathologic process remain unclear. (N Engl J Med 295:1217-1221, 1976). The use of perfusion preservation of cadaveric kidneys before transplantation provides time for necessary logistics and compatibility tests, may reduce the frequency of early post-transplant renal insufficiency¹²and may allow for assessment of donor-kidney function by the monitoring of perfusion characteristics.²³⁴It has been suggested, however, that one may be paying a price for these advantages. Anderson, Wyllie and Williams have described structural changes in perfusion-preserved animal and human kidneys,⁵and Clark et al. have reported decreased one-month and one-year survival rates in transplanted perfusion-preserved kidneys as compared with kidneys preserved by hypothermia alone.⁶To investigate the effect (or effects).