Kidney protection in preventing post-ischaemic renal failure during thoracoabdominal aortic aneurysm repair: does prostaglandin E1 together with cooling provide more protection than cooling alone?

BACKGROUND

Prostaglandin E1 (PGE1) is known to have a positive effect on kidney function after kidney ischaemia due to aortic clamping. Side effects of PGE1 are a decrease of systemic blood pressure and prevention of thrombocyte clotting, both being undesired during repair of thoracoabdominal aortic aneurysms (TAA). The aim of this study was to evaluate, whether intraoperative and intraarterial kidney perfusion with 4 degrees Ringer's lactate plus 1000 IU of heparin/l plus 20 micrograms PGE1/l is more effective in preventing postischaemic kidney dysfunction than cold perfusion without PGE1.

PATIENTS AND METHODS

In the time period from I/1996 until X/1998 58 patients underwent aortic repair for TAA type II, III, or IV (Crawford's classification). Ten patients fulfilled the criteria for this study: renal artery stenosis or occlusion was excluded by angiography pre- and postoperatively. By means of szintigraphy an at least 30% participation in renal function had to be proven for every kidney. Intraoperatively both kidneys had to be excluded from circulation simultaneously. The left kidney in each patient was perfused with 4 degrees Ringer's lactate plus 1000 IU of heparin/l plus 20 micrograms PGE1/l. The right kidney was perfused with a solution of the same temperature plus heparin but without PGE1.

RESULTS

There was an intermittent increase of creatinin and/or urea in each patient postoperatively. By renal szintigraphy, which was performed after a mean time of 9 (5-13) days postoperatively, a shift of renal function from one kidney to the other could be excluded.

CONCLUSION

In this experimental setting no additional benefit for kidney function could be detected, when under conditions of ischaemia kidneys were perfused with 4 degrees Ringer's lactate plus 1000 IU of heparin/l plus 20 micrograms PGE1/l compared to kidneys perfused with the same solution without PGE1.