A new method for conservative renal surgery ? experimental and first clinical results

Kallerhoff, M.; Blech, M.; Götz, L.-P.; Kehrer, G.; Bretschneider, H. J.; Helmchen, Udo; Ringert, R.‐H.

doi:10.1007/bf00185216

Cited by 18 publications

(6 citation statements)

References 32 publications

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“…This applies both to in situ protection in organ-preserving operations on the renal parenchyma [25, 9,15] and its use in the context of transplantation surgery [11]. Its use in extracorporeal kidney surgery ("workbench surgery") is also conceivable.…”

Section: Introductionmentioning

confidence: 98%

Electrolyte equilibration of human kidneys during perfusion with HTK-solution according to Bretschneider

et al. 1997

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Twelve surgically removed human kidneys (mainly tumor kidneys) were investigated. The investigations comprised perfusion criteria (perfusion flow, perfusion pressure, perfusion resistance, electrolyte equilibration). During perfusion of the kidneys with HTK solution, the perfusion resistance was nearly three times as high in human kidneys as in canine kidneys perfused under the same conditions in previous studies. Beside possible species differences the raised perfusion resistance may be explained by the greater trauma to the human kidneys due to the surgery, the primary ischemic stress which cannot be avoided clinically and the often nonoptimal initial diuresis. Nevertheless definitive perfusion is possible under clinical conditions although pronounced increases of perfusion resistance may occur. As indicated by the raised perfusion resistance of human kidneys under clinical conditions as compared with canine kidneys in an experimental model, electrolyte equilibration of human kidneys was protracted. For this reason, a duration of perfusion of at least 10 min is necessary in clinical application of HTK solution, i.e., longer than in animal experiments.

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Section: Introductionmentioning

confidence: 98%

Electrolyte equilibration of human kidneys during perfusion with HTK-solution according to Bretschneider

et al. 1997

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“…Versuchsgruppe: HTK-L6sung (Custodiol R) aus 120 cm Perfu-sionsh6he. Tryptophan stellt einerseits durch seine lipophilen Eigenschaften einen Schutzfaktor ftir die Zellmembran dar, auf der anderen Seite verhindert es einen Einstrom von Histidin in die Zelle durch Hemmung des Aminos~iuretransportsystems [13,20]. Versuchsgruppe: HTK-L6sungund 32 mmolAspartataus 120 cm Perfusionsh6he (Austausch des Chloridionenanteils durch Aspartat, da Chlorid mit Natriumionen in die Zelle einstr6men kann [12,20].…”

Section: Methodeunclassified

Ver�nderung der reninaktivit�t und des blutdruckverhaltens im autologen nierentransplantationsmodell am hund bei modifikation der HTK-l�sung

Ludwig¹,

Isemer

Kallerhoff³

et al. 1995

Langenbecks Arch Chir

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Investigations of changes in activity of renin and blood pressure after reperfusion of the kidney transplant using HTK solution were carried out by means of an autologous, heterotopic model of kidney transplantation applied to dogs. Duration of cold ischemia was 48 h. According to variations in the composition of the HTK perfusion solution three test groups were set up. During the first 20 min after recirculation in each test group the renal venous and arterial renin activities were measured. Parallel to renin activity, the arterial blood pressure was recorded. During the first few minutes following recirculation of the kidney transplant the renin levels in the venous blood of the kidney were higher in test group 1 (HTK solution, perfusion height 120 cm) than in either of the other two, showing a median maximal increase of 195 ng/ml.h. In test group 2 the maximal venous renin concentration fell to 145 ng/ml.h, while graphs take a more uniform course. Test group 3 (HTK/tryptophan) differed from the others in having further improved renin values. After the 7.5 min of observation normal venous renin concentrations were measured following earlier values for maximal increase between 23.1 ng/ml.h and 120 ng/ml.h (median 61.5 ng/ml.h). The best reperfusion of the kidney was observed in the tryptophan group, albeit without any recognizable positive effects on the other renal functions. Initially low renin values do not necessarily correlate with a smooth postoperative renal function and vice versa. Initial renin values cannot provide a secure basis for predicting instant as well as long-term postoperative functions.(ABSTRACT TRUNCATED AT 250 WORDS)

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“…In other solutions, lactobionic acid was either replaced or used in combination with the potent buffer histidine, and the edema-preventing capacity observed in the UW solution was conserved or even further improved [23,24]. Histidine is the first of three major components of another preservation solution, HTK solution, added to prevent acidosis and promote adenosine triphosphate (ATP) production during ischemia [25,26]. Ketoglutarate also acts to promote ATP production [27].…”

Section: Organ Storage Solutionsmentioning

confidence: 98%

The Critical Role of Bioenergetics in Donor Cardiac Allograft Preservation

Schipper

Marsh

Ferng

et al. 2016

J. of Cardiovasc. Trans. Res.

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The traditional philosophy of ex vivo organ preservation has been to limit metabolic activity by storing organs in hypothermic, static conditions. This methodology cannot provide longevity of hearts for more than 4-6 h and is thereby insufficient to expand the number of available organs. Albeit at lower rate, the breakdown of ATP still occurs during hypothermia. Furthermore, cold static preservation does not prevent the permanent damage that occurs upon reperfusion known as ischemia-reperfusion (IR) injury. This damage is caused by increased reactive oxygen species (ROS) production in combination with mitochondrial permeability transition pore (mPTP) opening, highlighting the importance of mitochondria in ischemic storage. There has recently been a major paradigm shift in the field, with emerging research supporting changes in traditional storage approaches. Novel research suggests achieving metabolic homeostasis instead of attempting to limit metabolic activity which reduces IR injury and improves graft preservation. Maintaining high ATP levels and circumventing cold organ storage would be a much more sophisticated standard for organ storage and should be the focus of future research in organ preservation. Given the link between mPTP, Ca2(+), and ROS, managing Ca2(+) influx into the mitochondria during conditioning might be the next critical step towards preventing irreversible IR injury.

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A new method for conservative renal surgery ? experimental and first clinical results

Cited by 18 publications

References 32 publications

Electrolyte equilibration of human kidneys during perfusion with HTK-solution according to Bretschneider

Electrolyte equilibration of human kidneys during perfusion with HTK-solution according to Bretschneider

Ver�nderung der reninaktivit�t und des blutdruckverhaltens im autologen nierentransplantationsmodell am hund bei modifikation der HTK-l�sung

The Critical Role of Bioenergetics in Donor Cardiac Allograft Preservation

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