[Surgical methods of cadaver nephrectomy prior to kidney transplantation (author's transl)].
Surgical technique during donor's binephrectomy is one of the most important parameters conditioning early success after kidney transplantation. Experimental studies showed that tractions on the renal pedicle during kidney removal had a detrimental effect upon renal cortical vascularization and subsequent kidney function. Cortical vasoconstriction is equivalent to acute warm ischemia and therefore impedes prolonged kidney preservation. The means of preventing such events are: administration of large volumes of intravenous saline to the donor, renal vasodilation during surgery with furosemide (8 mg/kg I.V.) repeatedly administered, continuous I.V. infusion of dopamine (less than 10 micrograms/kg/min) and last but not least, surgical technique. Renal pedicles should never be publed. Initial dissection of inferior vena cava, aorta and both renal pedicles is mandatory. Kidney dissection takes place at the very end of the operative procedure. In case of cardiocirculatory arrest, both kidneys are cooled in situ after retrograde cannulation of the aorta above the renal arteries with an indwelling probe inserted into the femoral artery in the groin. From January, 1876 to August 31, 1979, 83 cadavers have been operated upon according to these techniques. Warm ischemic time was less than 5 minutes in all cases. 85 kidneys have been sent to other kidney transplantation centers and 19 kidneys discarded. Sixty-two kidneys have been transplanted in our institution. Cold ischemic time ranged from 2 to 43 hours. Immediate post-transplant massive diuresis (greater than 2 ml/mn) was observed in all recipients but 3 (95%).