The reflush effect--a prospective analysis of late perfusion

Area of Science:

• Nephrology
• Transplantation Surgery
• Organ Preservation

Background:

• Kidney allograft preservation and implantation are critical for successful transplantation.
• Reperfusion injury can negatively impact early graft function.
• The effect of pre-implantation flushing on renal allografts requires further investigation.

Purpose of the Study:

• To evaluate the impact of a pre-implantation "reflush" using different preservation solutions on renal allograft function.
• To assess the effects of hyperosmolar citrate (HOC) and phosphate-buffered sucrose (PBS140) reflush on electrolyte balance and reperfusion injury markers.
• To compare the short-term and long-term outcomes of renal transplantation with and without reflush.

Main Methods:

• Prospective randomized trial involving three groups: HOC reflush, PBS140 reflush, and no reflush.
• Allografts were stored in HOC.
• Analysis of intra-/extracellular electrolytes, venous effluent, procoagulant activity in urine, and postoperative dialysis requirements.

Main Results:

• PBS140 reflush led to significant sodium and potassium loss from the kidney.
• Both reflush solutions released calcium and lactic acid into venous effluent, lowering pH.
• Reflushing reduced postoperative dialysis needs (40% to 15%), but no significant differences in renal function were observed by week one or at one year.

Conclusions:

• Pre-implantation reflush of renal allografts may mitigate early reperfusion injury and reduce the need for immediate postoperative dialysis.
• The proposed mechanism involves reducing calcium paradox and free radical formation.
• No significant long-term functional advantage was observed for either reflush method compared to no reflush.