This had the effect of increasing the speed of cooling of the kidney and removed red cells from the vascular system. These methods of surface cooling were improved by the introduction of techniques in which the kidney's vascular system was flushed out with cold fluid prior to storage. He also had a near survivor, after 24-hour kidney storage and delayed contralateral nephrectomy, in a dog that developed a late arterial thrombosis in the kidney. Schloerb also attempted in vitro storage and auto-transplantation of cooled kidneys, and had one long term survivor after 4 hours kidney storage followed by reimplantation and immediate contralateral nephrectomy. Stueber showed that kidneys would survive in situ clamping of the renal pedicle for 6 hours if the kidneys were cooled to 0-5 ☌ by being placed in a cooling jacket, and Schloerb showed that a similar technique with cooling of heparinised dog kidneys to 2-4 ☌ gave protection for 8 hours but not 12 hours. It was not until 1958 that it was shown that intact dog kidneys would survive ischaemia even better if they were cooled to lower temperatures. Moyer demonstrated the applicability of these dog experiments to the human, by showing the same effect on dog and human kidney function from the same periods of hypothermic ischaemia. This protective effect of hypothermia on renal ischaemic damage was confirmed by Bogardus who showed a protective effect from surface cooling of dog kidneys whose renal pedicles were clamped in situ for 2 hours. The beneficial effect of hypothermia on ischaemic intact kidneys was demonstrated by Owens in 1955 when he showed that, if dogs were cooled to 23-26 ☌, and their thoracic aortas were occluded for 2 hours, their kidneys showed no apparent damage when the dogs were rewarmed. When the slices were rewarmed to 37 ☌ their oxygen consumption recovered to normal. Fuhrman showed that slices of rat kidney cortex and brain withstood cooling to 0.2 ☌ for one hour at which temperature their oxygen consumption was minimal. Prior to this, kidneys had been stored at normal body temperatures using blood or diluted blood perfusates, but no successful reimplantations had been made. The crucial step in making in vitro storage of kidneys possible, was the demonstration by Fuhrman in 1943, of a reversible effect of hypothermia on the metabolic processes of isolated tissues. In these experiments kidneys were transplanted without there being any attempt at storage. Carrel went on to describe the first kidney transplants, which were performed in dogs in 1902 Ullman independently described similar experiments in the same year. Diagram of normothermic regional perfusion of abdominal organs preparation for transplantationĪn essential preliminary to the development of kidney storage and transplantation was the work of Alexis Carrel in developing methods for vascular anastomosis.
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