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Hilar drainage fluid of dog kidneys was analyzed as an approximation to renal extracellular fluid after preservation by flushing with chilled high K-low Na solution (Collins C4) followed by ice-cold storage for 24 and 48 hr in a bath of flushing medium. Compared with the medium, Na and Cl were increased to 30 mM/liter and K decreased slightly to 93 mM/liter. Glucose decreased, whereas lactate, lactic dehydrogenase, and creatine phosphokinase increased by significant amounts in both the drainage fluid and bath. The inulin space of the undrained kidney average 37% of wet weight. Calculated intracellular Na and Cl concentrations averaged 50 and 37 mM/kg cell water while K remained within normal limits. A significant fraction of red blood cells retained during initial flushing entered the effluent during storage. Bath and effluent composition of a human cadaver kidney approximated those of a dog.

Two cadaver kidneys were preserved by the perfusion method with AB cryoprecipitated plasma which contained antidonor lymphocytotoxic antibody. The kidneys were transplanted subsequently and no demonstrable immunologic damage to the kidneys was observed in the preservation and post-transplantation periods. In one patient renal function was immediate, and function has remained satisfactory in the 3 month follow-up period. The other patient had an initial period (2 weeks) of acute tubular necrosis, but renal function became satisfactory and the patient's condition has remained stable in the 3 month follow-up period. The significance of antidonor lymphocytotoxic antibody in the plasma perfusate on subsequent kidney function has been discussed.

We measured prospectively changes in fractional protein clearance ratio (CPr/CCr) in 21 live-related (LR) and 41 cadaver donor (CD) renal transplants before and during onset of first rejections. Fifty-three recipients manifested a rejection within the first post-transplant month. Fractional protein clearance increased in all patients during rejection. An increase in CPr/CCr prior to other evidence of impending rejection, and therefore clinically useful, required at least a 10-day rejection-free interval dated from onset of diuresis (whether diuresis was immediate or delayed by acute tubular necrosis (ATN)). Twenty-three of 25 nonantilymphocyte globulin (ALG)-treated CD transplants manifested clinical and laboratory signs of the first rejection episode prior to the 10th day of diuresis compared with 5 of 21 LR and none of 16 ALG-treated CD transplants. Persistence of elevated CPr/CCr despite treatment forecast graft loss (11 of 13), whereas a decrease in this ratio was associated with ultimate reversal of the rejection process.

A method for the excision of human cadaver kidneys for transplantation is described that features en bloc removal with preservation of all vessels, in situ cooling, and rapid preparation of well-dissected organs for transplantation.