Renal autotransplantation using hypothermic storage and pulsatile perfusion

Three patients with severe hypertension secondary to renal artery stenosis were treated by renal autotransplantation. Of these 3 patients 2 had solitary kidneys and 1 had 2 renal arteries to each kidney, all of which were stenosed. Renal autotransplantation with hypothermia of the kidney was performed in all 3 patients rather than the more conventional arterial bypass or endarterectomy because 1) hypothermic preservation permitted a prolonged ischemia time and 2) there was improved exposure for the vascular anastomosis. Postoperatively 2 patients remained normotensive without drugs for 9 and 12 months and 1 patient died of septicemia not directly related to the autotransplant. All 3 patients required expansion of the intravascular volume postoperatively to overcome the loss of vasoconstrictor substances following restoration of renal blood flow.