PROSTAGLANDIN E-1 IMPROVES PULSATILE PRESERVATION CHARACTERISTICS ANDEARLY GRAFT FUNCTION IN EXPANDED CRITERIA DONOR KIDNEYS

Unlike simple cold storage, machine preservation allows dynamic assess ment and manipulation of the donor organ before transplantation. The e ffects of four pharmacologic agents added to the perfusate during mach ine preservation of expanded criteria donor (ECD) kidneys were prospec tively compared to 1) describe their influence on perfusion parameters and 2) determine their influence on early graft outcome. Between 1 Ja nuary 1995 and 1 October 1997, 125 consecutive ECD kidneys were preser ved in the authors' laboratory. A definition of ECD was assigned to ki dneys requiring pretransplant biopsy. The ECD kidneys were randomized to receive prostaglandin E-1 (PGE(1)), trifluoperazine (TFP), verapami l (VER), mannitol (MAN), or no intervention (control) during machine p reservation. All kidneys were preserved by continuous hypothermic puls atile perfusion (CHPP) using Belzer II solution, and perfusion paramet ers were measured every 2 hours during pulsatile perfusion. The additi on of PGE, to the perfusate increased renal flow and decreased renal r esistance. Moreover, the PGE1 treated group was associated with improv ed early graft function when compared with all other groups. The addit ion of VER, TFP, and MAN influenced neither the perfusion characterist ics nor the incidence of early graft function. Treatment with PGE, dur ing machine preservation enhances hydrostatic perfusion parameters (re nal flow and renal resistance) and reduces the incidence of delayed gr aft function in ECD kidneys.