Air embolization during the machine preservation of kidney

Air embolization during machine preservation of kidneys for transplantation occurred in seven of 218 kidneys. In three it occured during transportation on a portable machine. On arrival they had warmed up and were discarded. In four kidneys air embolization occured in the laboratory and was detected immediately. Upon re-establishment of perfusion, there was a sharply lower flow and a higher diastolic pressure. Within 30 to 120 minutes the flow reached the pre-embolization rate and the diastolic pressure stabilized at a slightly higher level than before embolization. One recipient died 2 months after transplantation due to infection, and one kidney was removed because of rejection after 32 days. Two patients receiving the mates to the above kidneys were discharged with excellent kidney function. If the exact time of air embolization cannot be determined, it is prudent to discard the kidneys. This indicates the importance of continuous supervision during the perfusion. When air embolization occurs in the laboratory and is detected immediately, the kidney should be evaluated carefully. If, after correction of the defect, the perfusion and diastolic pressure reach the neighborhood of pre-embolization levels within 30 to 120 minutes with no patchy discoloration, the kidney is suitable for transportation. Discarding kidneys with air emboli without proper evaluation is not justifiable.