Preservation of ischemically injured canine kidneys by retrograde oxygen persufflation

Canine kidneys were briefly perfused with Ross and Marshall's hypertonic citrate solution and stored at O C. This study concerns the effect, during such storage, of insufflating various gases via the renal vein and allowing the gas to escape through needle perforations of the renal surface. We were able to confirm the finding of Ross and Escott that kidneys that have suffered 30 min of warm ischemia prior to preservation, will, if oxygen is so "persufflated" during 24 hr storage, provide life-supporting function when subsequently auto-grafted. Moreover, we were able to extend the preservation period to 48 hr after 30 min warm ischemia, and to achieve 24-hr preservation after 60 min of warm ischemia. Oxygen was essential: our results suggest that air is less effective than pure oxygen, and we found inert gases to be completely ineffective. Uniformly high oxygen tensions were measured throughout the kidneys during storage, but we were unable to demonstrate any resynthesis of adenosine triphosphate and adenosine diphosphate. The mechanism responsible for the effectiveness of retrograde oxygen persufflation remains obscure.