The effect of chlorpromazine on preservation of kidneys with one hour of warm ischaemia

Effects of chlorpromazine and methylprednisolone on perfusion preservation of rabbit livers

The isolated perfused rabbit liver was used to determine how continuous hypothermic perfusion affected liver function. Rabbit livers were perfused for 0, 24, 48, and 72 hr at 5 degrees C with the UW perfusate containing hydroxyethyl starch (5 g%) dissolved in a solution containing gluconate (80 mM), adenosine (5 mM), glutathione (3 mM), phosphate (25 mM), and additives as described previously, and they were used successfully for kidney preservation. At the end of preservation the livers were perfused in an isolated circuit with a Krebs-Henseleit solution with addition of 4 g% bovine serum albumin and 10 mM glucose at 38 degrees C for 120 min. Bile was collected from the cannulated common duct. Biliary excretions of indocyanine green and liver enzymes lactate dehydrogenase, aspartate aminotransferase, and alanine aminotransferase, were determined both in the cold perfusate and the normothermic perfusate. Livers were also studied after pretreatment of the donor with chlorpromazine (CPZ) and/or methylprednisolone (MP). Bile production (ml/120 min, 100 g liver) upon reperfusion produced the most interesting data and decreased from a control value of 10.3 +/- 2.6 to 9.3 +/- 1.0 (24 hr), 5.3 +/- 0.7 (48 hr), and 4.1 +/- 1.5 (72 hr). Enzyme release was not predictive of the degree of preservation-induced damage. Pretreatment of rabbits with a combination of CPZ/MP improved bile flow at 48 and 72 hr (8.3 +/- 3.0 and 7.0 +/- 1.3, P less than 0.05). Pretreatment with either drug alone also improved function after 72 hr of preservation (7.1 +/- 1.8, CPZ; 8.2 +/- 3.5, MP).(ABSTRACT TRUNCATED AT 250 WORDS)

Coenzyme A in dog kidneys during hypothermic perfusion

In kidneys perfused hypothermically for 48 hr, both major intracellular pools of CoA (present in cytosol and mitochondria) decreased when solutions with intracellular or extracellular electrolyte composition without CoA precursors were used. The presence of substrates such as glucose or caprylic acid in the perfusate did not counteract the depletion of CoA. The addition of the CoA precursors pantethine and adenosine together with respiratory substrates to the perfusion medium counteracted the loss of CoA. The best solution in this respect among 16 different perfusates tested contained palmitic acid and L-carnitine together with CoA precursors and dibutyryl cyclic AMP. With this solution, we obtained good preservation of the cytosolic and the mitochondrial pool of CoA.

Urid acid accumulated in isolated kidney grafts: an assessment of agonal ischaemia

Hypoxanthine-xanthine washed out from kidney tissue during preservation has previously been found to be a reliable measure of the in vitro assessment of the deleterious effect of ischaemia on the functional regenerative ability of the graft. We have now studied the question: can uric acid accumulation in the isolated kidney graft be employed as a retrospective measure of the agonal ischaemia? We have found that uric acid alone accumulates in renal tissue during the agonal phase, in an amount that remains unchanged during the subsequent in vitro ischaemia. The determination of hypoxanthine-xanthine and uric acid in kidney perfusate samples during preservation must thus be presumed to be an optimal clinical-chemical method of assessing the graft ischaemia.

The effect of chlorpromazine pretreatment on renal function and pathology in kidneys damaged by warm ischaemia

The influence of chlorpromazine pretreatment on kidney function and survival after temporary occlusion of the renal artery was investigated. Three hours of clamping of the renal artery and contralateral nephrectomy was performed in a group of ten rabbits pretreated with 3.5 mg/kg chlorpromazine and compared with a previously published control group of untreated animals. Chlorpromazine pretreatment improved survival. The kidney function, estimated by serum-creatinine, showed an earlier onset of function and the surviving animals regained nearly normal function. Histological examination revealed mild to moderate ischaemic changes, whereas the control group showed more profound damages.

Effects of different doses of chlorpromazine on renal function in the dog

This study was carried out to examine the effects of low 'alpha-blocking' and higher 'membrane-stabilizing' doses of chlorpromazine (CPZ) on renal function. CPZ was given at slow infusion rate either intravenously or into the left renal artery at three levels (0.5-1.0, 3-8, and 10-15 mg/kg) to 10 anesthetized dogs. An increase in plasma hemoglobin sometimes occurred within few minutes after infusion of more than 10 mg/kg CPZ, probably due to a hemolytic effect of such high doses. Systemic infusion of 0.5-1 mg/kg CPZ caused an increase in urine volume, sodium excretion, and renal plasma flow, and a decrease in filtration fraction and free water clearance was demonstrated in all dogs. At higher CPZ doses renal plasma flow increased further, whereas urine volume and electrolyte excretion were of the same order at all dose levels. A 21% decrease in tubular maximum para-aminohippurate transport (Tm(PAH)) was observed at the highest CPZ doses. After unilateral renal intra-arterial CPZ infusion the percentage change in urine volume, urinary sodium excretion, and Tm(PAH) were of the same order on the infused side as on the contralateral side. Even though the results at all dose levels can be explained by an 'alpha-blocking' effect of CPZ, possible membrane-stabilizine effects of CPZ cannot be excluded.

The uptake of hippuran in kidney slices employed as a viability test

125J Hippuran uptake in slices from rabbit kidneys was measured in kidneys damaged by warm ischaemia alone as well as by warm ischaemia combined with 24 hours of cold ischaemia. The Hippuran uptake was calculated as the ratio between radioactivity in the slices and the activity in the incubation medium as a slice/medium ratio (S/M). S/M was unchanged after 15 minutes, 30 minutes and 1 hour of warm ischaemia, while in kidneys exposed to 2 hours of warm ischaemia a 15% decrease in S/M ratio compared with control values was noted. A 53% decrease was observed after 3 hours of warm ischaemia and 73% and 91% after 4 and 5 hours respectively. Twenty-four hours of cold ischaemia alone did not alter the Hippuran uptake, but prolonging this with 15 minutes of warm ischaemia precipitated a significant fall (25%) in S/M. This value remained constant during the first hour of warm ischaemia, but a fall of 64% was observed after 2 hours of warm and 24 hours of cold ischaemia. These findings were in agreement with experiments on kidneys damaged by arterial occlusion and recirculated. Two hours of warm ischaemia was the maximal damage the kidneys could endure and still regain normal function. After simple preservation methods with Collins solution for 24 hours, 1 additional hour of warm ischaemia was the maximal ischaemic damage the kidney was able to withstand. Hippuran uptake in kidney slices appears to be well correlated to the kidneys' ability to regain normal function after ischaemic damage.

The effect of chlorpromazine pretreatment on tubular function in kidney preservation

The effect of Chlorpromazine pretreatment on tubular function was investigated. Hippuran uptake in cortex slices from rabbit kidneys was measured after one hour of incubation in a medium containing Hippuran. Before measurement the kidneys were exposed to varying periods of warm ischaemia or/and cooled and preserved for 24 hours in Collins solution. Chlorpromazine treated and untreated groups of animals were compared, the results obtained were identical in both groups. In contra distinction to these findings, addition of Chlorpromazine to the incubation fluid inhibited uptake of Hippuran in the kidney slices. The effects of pretreatment with Chlorpromazine on the kidney function after ischaemic damage were demonstrated. Serum-creatinine and survival were compared in a treated and an untreated group after 3 hours of temporary clamping of the renal artery. Pretreatment resulted in earlier onset of function and better survival. It is concluded that the antimetabolic effect of Chlorpromazine is opposed to its vasodilatory properties is of little practical importance for the viability of the kidney damaged by ischaemia.