INTRAOPERATIVE MEASUREMENT OF PARTIAL-PRE SSURE OF OXYGEN IN THE RENAL-CORTEX DURING KIDNEY-TRANSPLANTATION - EFFECT OF THE CALCIUM DILTIAZEM

A local measurement of the partial pressure of oxygen in the renal cor tex was performed during renal transplantation in 40 patients aged bet ween 10 and 62 years. During the measurement, 20 of the patients recei ved the calcium channel blocker diltiazem. Accurate knowledge of the r enal microcirculation in the postischemic phase became possible when P O2 tissue polarography was performed. Moreover, measurement in four li ve donors before removal of the kidneys allowed an exact comparison be tween the postischemic microcirculation and the native in situ perfusi on. A good postischemic baseline histogram (similar to the situation i n a live donor) or quick stabilization of the histogram during the cou rse was found to correlate with a prompt initial renal function. Intra -arterial administration of diltiazem led to an insignificant improvem ent of the primary function rate. In the case of kidneys with longer c old ischemic periods and initially indifferent baseline histograms the re was an especially pronounced benefit of diltiazem administration. N ot only macroscopic examination, but also polarographic measurements r evealed an improvement in the penal microcirculation throughout, with higher mean values for PO2 and homogeneity of all PO2 values measured after administration of diltiazem. In keeping with this, in such cases the incidence of primary renal function was distinctly higher. In cas es with improved cortical circulation the a-v oxygen difference was le ss pronounced, so that evaluation of the avDO(2) determinations sugges ts distinct perfusion improvement following diltiazem. Moreover, durin g a medium-term follow up, there were also fewer rejection episodes in the diltiazem group than in the so-called native group.