Electrolyte equilibration of human kidneys during perfusion with HTK-solution according to Bretschneider

Abstract

Twelve surgically removed human kidneys (mainly tumor kidneys) were investigated. The investigations comprised perfusion criteria (perfusion flow, perfusion pressure, perfusion resistance, electrolyte equilibration). During perfusion of the kidneys with HTK solution, the perfusion resistance was nearly three times as high in human kidneys as in canine kidneys perfused under the same conditions in previous studies. Beside possible species differences the raised perfusion resistance may be explained by the greater trauma to the human kidneys due to the surgery, the primary ischemic stress which cannot be avoided clinically and the often nonoptimal initial diuresis. Nevertheless definitive perfusion is possible under clinical conditions although pronounced increases of perfusion resistance may occur. As indicated by the raised perfusion resistance of human kidneys under clinical conditions as compared with canine kidneys in an experimental model, electrolyte equilibration of human kidneys was protracted. For this reason, a duration of perfusion of at least 10 min is necessary in clinical application of HTK solution, i.e., longer than in animal experiments.

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“…It is possible that histidine, tryptophan, and ketoglutarate in a hypothermic condition do not allow lactic acid to exude and collect; however, decreased levels of sodium and calcium and increased levels of potassium allows making organ preservation efficiently in hypothermic conditions. Our data are comparable with previous results 7 in which different reductions in levels of potassium and sodium ions were shown within 10 minutes between preservation solution and the effluent after kidney perfusion. Differences in glucose values were not statistically In addition, we found that the osmolality results in explanted samples with satisfactory function after renal transplant were closer to the preservation solution's reference value versus that shown in explanted samples from dysfunctional kidneys after transplant.…”

“…An important condition of preservation solution is its protective function (that is, to quickly balance electrolytes in the extracellular renal space and in the preservation solution). 7 When organs are flushed during retrieval, the effluent's metabolic parameters, electrolyte balance, and osmolality are at different levels versus the reference values of our preservation solution. To allow the effluent to reach the reference ranges of the preservation solution, an additional kidney perfusion at the back table stage is needed.…”

“…6 An important condition for organ protection is the balance of electrolytes in the extracellular space of a kidney transplant and the content of electrolytes in the preservation solution. 7 Prediction of graft dysfunction allows for the possibility to change the treatment strategy. In this study, we investigated the metabolic, electrolyte composition, and the osmolality of the preservation solution effluent to identify new predictors of initial kidney transplant dysfunction.…”

Physiologic and metabolic results of pancreatic cold storage with Histidine-Tryptophan-Ketoglutarate-HTK solution (Custodiol)® in the porcine autotransplantation model

“…This resulted in a slow electrolyte equilibration process, most noticable after 4min for the sodium rather than for potassium, with appearance of interstitial graft edema. This process is already known from experimental HTK perfusion models with human kidneys [2]. In human kidneys, the difference in the sodium concentration between the perfusion solution and the venous effluence is more prominent during the first 2 min of perfusion.…”

“…However, the buffering capacity depends on an equilibration of the electrolyte composition in the graft's extracellular space to the electrolyte content of the protective solution. This equilibration has previously been studied for canine and human kidneys, emphasising the importance of adequate organ perfusion with HTK-solution [2]. The influence of this equilibration process and functional results in vivo are unknown since pancreatic physiology and metabolism were studied only in vitro using a perfusion chamber [14,15].…”