[Prevention of ischemia before cold ischemia by pharmcologic donor conditioning--experimental findings]

The loop-diuretic piretanide was used to study the influence of pharmacological donor pretreatment on immediate postischemic function in a pig model of kidney transplantation based on the results of a clinical pilot study [4]. Following laparotomy, both kidneys were flushed via a transaortal catheter with Eurocollins-solution and surgically removed. A cold ischemic period of 1 or 24 h was chosen. After that period, kidneys were reperfused with intraoperatively drawn heparinized blood for one hour. We used a special instrument for hemoperfusion of isolated organs which allows perfusion for several hours under steady-state conditions. Four groups were formed: Control and piretanide, 1 or 24 h cold ischemia. The perfusion of piretanide-treated organs resulted in a lower perfusion-resistance, calculated as pressure/flow-ratio or as pressure/glomerular filtrationratio. The flow in the pretreated group was higher, thus excluding a higher shunt-volume. In parallel, oxygen consumption as a parameter of postischemic function start and creatinine clearance were higher in the piretanide treated groups. The experiments demonstrate a superior postischemic function of pretreated kidneys in comparison to control organs after 1 and 24 hours of cold ischemia in this model.