Relationship of Perfusion Pressure to the Microcirculation of the Preserved Canine Kidney

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Abstract
Thirty-four dog kidneys were perfused with an electrolyte solution of Dextran for periods up to 48 hours. The perfusion pressures ranged from 22 to 175 mm Hg. Following the hypothermic preservation, whole kidney angiograms and microangiograms were prepared. Adequate filling of the microvasculature of the kidney was obtained with pressures in excess of 22 mm Hg. Kidneys having perfusion pressures of 22-36 mm Hg were adequately perfused as shown by completely normal microangiograms. Kidneys for which perfusion pressures rose to 37-73 mm Hg showed abnormal microangiograms with areas of malperfusion in 59% of the cases. Kidneys for which perfusion pressures rose to 74-175 mm Hg all had abnormal microangiograms with areas of malperfusion. The areas of malperfusion were not related to duration of the perfusion or the position of the kidneys during the perfusion. Histological sections taken from 12 kidneys suggest that the areas of malperfusion can either be related to events occurring prior to perfusion or secondary to the development of edema during the perfusion. Areas of malperfusion involving up to 50% of the renal parenchyma were frequently not visualized on the gross angiograms, but were seen on the microangiograms. We conclude that only in those kidneys whose perfusion pressures remain in the range 22-36 mm Hg can we be reasonably certain the microvasculature is adequately perfused. Gross angiography is not an accurate means of assessing the adequacy of renal perfusion during preservation procedures.

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