Arterial and pedicle occlusion in the hypothermic pig kidney.

Previous laboratory investigation has indicated that during induction of ischaemia the renal artery should be occluded in preference to the whole pedicle. However, in clinical practice the distinction between these may have only a trivial bearing on subsequent renal function compared with the effect of surgery on the parenchyma. The present work was designed to investigate the effects of pedicle and arterial occlusion on the pig kidney after 90 min of hypothermic ischaemia. However, 2 other groups having nephrotomy were also included to give the study more clinical relevance. The results showed that the combination of nephrotomy and pedicle occlusion gave a significant rise in plasma creatinine in the first 48 h post-operatively compared with the other groups. However, there was no difference between the 4 groups after 8 days and 28 days. Histology of the kidneys removed after 28 days showed comparatively minor changes in terms of glomerular and tubular structural abnormality. Furthermore the vasculature was well preserved though an inflammatory infiltrate was usually found. Semi-quantitative analysis of these changes showed that, paradoxically, they were generally less severe with pedicle than arterial occlusion. Another surprising result of this analysis was that the addition of nephrotomy appeared to be beneficial.