Kidney protection in preventing post-ischaemic renal failure during thoracoabdominal aortic aneurysm repair: does prostaglandin E-1 together with cooling provide move protection than cooling alone?

Background Prostaglandin El (PGE(1)) is known to have a positive effect on kidney function after kidney ischaemia due to aortic clamping. Side effects of PGE(1) are a decrease of systemic blood pressure and prevention of thro mbocyte clotting both being undesired during repair of thoracoabominal aort ic aneurysms (TAA). The aim of this study wets to evaluate, whether intraop erative and intraarterial kidney perfusion with 4 degrees Ringer's lactate plus 1000 IU of heparin/l plus 20 mug PGE(1)/l is more effective in prevent ing postischaemic kidney dysfunction than cold perfusion without PGE(1). Patients and methods: In the time period from I/1996 until X/1998 58 patien ts underwent aortic repair for TAA type II, Ill, or IV (Crawford's classifi cation). Ten patients fulfilled the criteria for this study: renal artery s tenosis or occlusion was excluded by angiography pre- and postoperatively. By means of szintigraphy an at feast 30% participation in renal function ha d to be proven for every kidney. Intraoperatively both kidneys had to be ex cluded from circulation simultaneously The left kidney in each patient was perfused with 4 degrees Ringer's lactate plus 1000 IU of heparin/l plus 20 mug PGE(1)/l. The right kidney was perfused with a solution of the same tem perature plus heparin but without PGE(1). Results: There was an intermittent increase of creatinin and/or urea in eac h patient postoperatively. By renal szintigraphy, which was performed after a mean time of 9 (5-13) days postoperatively, a shift of renal function fr om one kidney to the other could be excluded. Conclusion: In this experimental setting no additional benefit for kidney f unction could be detected, when under conditions of ischaemia kidneys were perfused with 4 degrees Ringer's lactate plus 1000 IU of heparin/1 plus 20 mug PGE1/l compared to kidneys perfused with the same solution without PGE( 1).