Simple Kidney-storage Technique

Several years ago we did not seriously consider removing kidneys from healthy living people and transplanting them to uraemic patients. The obvious plan was to store kidneys for subsequent transplantation. The problems involved in storage were not underestimated. It was pointed out : If the immunological problems and other problems involved in procuring a normal functioning organ were solved our difficulties would be by no means over. There would still remain the problem of storage of organs. This presents many difficulties. While there is no difficulty in preserving skin and blood-vessels in the frozen state, other organs, such as kidney, would require more delicate handling. It is possible that an organ-perfusion apparatus may turn out to be the only safe method of preserving delicate organs ready for homotransplantation at any given (Dempster, 1951). However, the results of transplanting cadaveric kidneys were disappointing because of a high rate of immediate anuria or oliguria, although occasionally function was resumed several days later (Hume et al., 1955). The pioneering effort of Oeconomos et al. (1953), using a fresh kidney, impressed us and influenced our attitude to the donor problem for several years. A scientific contraindication, we think, to continuing with live donors at this juncture is the high incidence of a curious complication of obliterative and other vascular lesions involving kidneys some time after homotransplantation and leading inevitably to anuria and death of the patient. A blood-perfusion machine presents many difficulties, and unless oxygenated blood is used perfusion can be definitely harmful because the perfused organ becomes oedematous (Nizet and Cuypers, 1962). Even when oxygenated blood is used vasoconstrictor substances are liberated and damage to the isolated kidney consistently develops after a period of about three hours. Perfusion of the whole cadaver would overcome many problems involving vasoconstrictor substances. There would appear to be better prospects for this method of perfusion than for perfusing the isolated kidney. However, both methods involve teams of workers who must be prepared at any moment to go into action. This may not be practicable in some hospitals and hence our attempt to reassess cooling. Simple methods, such as storage in a refrigerator at 4? C, have often been employed, but the results have been inconsistent (Kiser et al., 1961). Several years ago we were unable to confirm the results of Lefebvre (1951), who used refrigerator storage. Lefebvre and Nizet (1952) reported and illustrated very well the total medullary damage which we found consistently and which they encountered in some of their experiments (see Fig.). Lapchinsky (1960) reported that autotransplanted kidneys can be perfused in a blood-flow circuit within a refrigerator. However, his technique was not successful for homotransplanted kidneys, which is our main concern at the moment.