[Intraoperative cortical PO2 measurement in kidney transplantation. the effect of the calcium antagonist diltiazem]

Abstract

A local measurement of the partial pressure of oxygen in the renal cortex was performed during renal transplantation in 40 patients aged between 10 and 62 years. During the measurement, 20 of the patients received the calcium channel blocker diltiazem. Accurate knowledge of the renal microcirculation in the postischemic phase became possible when PO2 tissue polarography was performed. Moreover, measurement in four live donors before removal of the kidneys allowed an exact comparison between the postischemic microcirulation and the native in situ perfusion. A good postischemic baseline histogram (similar to the situation in a live donor) or quick stabilization of the histogram during the course was found to correlate with a prompt initial renal function. Intra-arterial administration of diltiazem led to an insignificant improvement of the primary function rate. In the case of kidneys with longer cold ischemic periods and initially indifferent baseline histograms there was an especially pronounced benefit of diltiazem administration. Not only macroscopic examination, but also polarographic measurements revealed an improvement in the renal microcirculation throughout, with higher mean values for PO2 and homogeneity of all PO2 values measured after administration of diltiazem. In keeping with this, in such cases the incidence of primary renal function was distinctly higher. In cases with improved cortical circulation the a-v oxygen difference was less pronounced, so that evaluation of the avDO2 determinations suggests distinct perfusion improvement following diltiazem.