[New perspectives in the preservation of kidney grafts]. / Nuevas perspectivas en la preservación de injertos renales.

OBJECTIVES: Graft preservation, together with overcoming the immunological barrier responsible for graft rejection, are the most important problems of organ transplantation. The different solutions to the foregoing problems are briefly analyzed. METHODS/RESULTS: The literature on graft rejection and preservation is briefly reviewed, highlighting the most outstanding developments. The availability of cyclosporine in the early eighties significantly enhanced the results of immunosuppression and made it less aggressive for graft recipients. The use of liquids for hypothermic preservation of the donor organ, with the advantages and disadvantages it entailed, was a major advancement in cold ischemia. Different solutions (Eurocollins, Wisconsin, HTK) were developed to reduce metabolic derangements from the time the organ was harvested until it was transplanted, with the aim of permitting immediate graft function in order to reduce the incidence of acute tubular necrosis. Further insight into the histological lesions caused by ischemia, the endothelial lesion and its role in tubular dysfunction have led different groups to use pulsatile perfusion once again, particularly since non-heartbeating donor programs were developed. CONCLUSIONS: Although the advancements in the preservation of renal grafts have permitted extending the cold ischemia time beyond 24 hours, the incidence of tubular necrosis continues to be significant. The foregoing, together with the development of renal transplant programs for non-hearbeating donor kidneys, have emphasized the need for further knowledge and understanding of graft viability and early function.