[Continuous in situ cold perfusion with HTK solution in conservative surgery of kidney tumor]

Ex situ protection of donor organs for transplantation with initial cold perfusion is routinely used. The superiority of histidine-tryptophan-ketoglutarate solution (HTK) has been demonstrated in animal models and clinical use, however. On the other hand, nephron-sparing surgery for surgical or functional solitary kidneys has been an established procedure for many years. Owing to wide use of ultrasound and computerized tomography, the detection of small renal tumors has increased. New concepts in conservative renal surgery are therefore gaining in importance. In this study we report on 11 patients with renal masses in a surgical or functional solitary kidney. For the first time, all enucleations were performed with continuous in situ perfusion with HTK solution. Despite extensive tumors with central extension, complete in situ tumor resection and kidney reconstruction were possible. There were no intraoperative complications. Postoperatively one kidney was lost secondary to renal artery embolism. Urine production started within 1 h postoperatively in all other cases. No further patients needed hemodialysis. Apart from temporary elevation of serum creatinine, postoperative renal function was unimpaired. There were no changes in serum electrolytes and no disorders of cardiac conduction. The indications, the surgical procedure and the first clinical results of continuous in situ perfusion with HTK solution for conservative renal surgery are presented.