raffinose and Kidney-Tubular-Necrosis--Acute

A study was performed to compare early allograft function in kidneys preserved with University of Wisconsin (UW) solution to kidneys preserved by hypothermic pulsatile perfusion. The study consisted of two sets of data. The first set was a donor-paired study (matched data) of 30 heart-beating, hemodynamically stable donors. After removal from the donor each cooled kidney was individually prepared for preservation. One kidney was flushed with +/- 500 ml of UW solution and stored in UW solution on slushed ice. The other kidney was continuously perfused with cooled (4-6 degrees C) cryoprecipitated plasma. The kidneys were transplanted into suitable recipients in a random sequence. Twelve donors were excluded from the study because one or both kidneys were transplanted into recipients who had previously been transplanted. The remaining 36 kidneys were implanted into two similar groups after a mean of 19 hours in the pulsatile perfusion group and 18 hours in the UW solution group. The second set of data consisted of all the kidneys preserved in UW solution (n = 62) at our institution and of 57 kidneys preserved by hypothermic continuous pulsatile perfusion during the same period (mixed data) and was used to evaluate the effect of prolonged preservation (longer than 24 hours) on delayed graft function. Both of these groups were also comparable. Acute tubular necrosis (ATN) was defined as the need for dialysis during the 1st week after transplantation, and delayed function as the delayed clearance of creatinine during the early post-operative phase.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adenosine; Adolescent; Adult; Allopurinol; Child; Child, Preschool; Cold Temperature; Glutathione; Graft Survival; Humans; Infant; Insulin; Kidney; Kidney Transplantation; Kidney Tubular Necrosis, Acute; Middle Aged; Organ Preservation; Organ Preservation Solutions; Postoperative Complications; Pulsatile Flow; Raffinose; Time Factors; Transplantation, Homologous

Topics: Adenosine; Adult; Allopurinol; Cadaver; Cause of Death; Female; Glutathione; Histocompatibility Testing; Humans; Hypertonic Solutions; Immunosuppression Therapy; Incidence; Insulin; Kidney; Kidney Transplantation; Kidney Tubular Necrosis, Acute; Male; Organ Preservation; Organ Preservation Solutions; Raffinose; Tissue Donors; Transplantation, Homologous

Topics: Adenosine; Adult; Allopurinol; Animals; Cadaver; Chlorpromazine; Creatinine; Disaccharides; Dogs; Glutathione; Graft Survival; Humans; Hypertonic Solutions; Insulin; Kidney Transplantation; Kidney Tubular Necrosis, Acute; Organ Preservation; Organ Preservation Solutions; Raffinose; Solutions; Sucrose; Time Factors; Tissue Donors

The goal of this research is to make a comparative analysis of acute tubular necrosis (NTA) incidence in function of preservation solution used: Wisconsin vs Celsior.. From January 1994 to December 2002, 229 kidney transplantation procedures were executed; 190 of them were perfused with Wisconsin (82.9%) and 39 with Celsior (17.1%). After checking the statistical homogeneity of both groups, we analysis comparatively the incidence of NTA and the evolution of serum creatinine in function of preservation solution utilized.. There was not statistical significant difference in NTA incidence between Celsior (23%) and Wisconsin group (36%). We assessed that each group were comparable with regard to NTA incidence of subgroups with cold ischemia times longer 12 hours. Creatinine serum in Celsior group tended to be lower than Wisconsin group at 1, 3, 6 and 12 months posttransplantation (statistically significant difference, p<0.05). Kidney preservation in Celsior solution provides similar results to the ones obtained in Wisconsin solution in relation with NTA incidence and kidney function with the added advantage of a lower cost.

Topics: Adenosine; Adult; Allopurinol; Disaccharides; Electrolytes; Female; Glutamates; Glutathione; Histidine; Humans; Incidence; Insulin; Ischemic Preconditioning; Kidney Transplantation; Kidney Tubular Necrosis, Acute; Male; Mannitol; Middle Aged; Organ Preservation Solutions; Raffinose; Retrospective Studies; Time Factors

To determine whether Belzer solution (Viaspan, Bristol-Myers Squibb, Brussels, Belgium), which is more expensive than Eurocollins solution, was better at preventing delayed graft function (DGF) and whether it was cost-effective as it could potentially reduce post-transplantation complications.. The risk of occurrence of complications associated with the use of these two rinsing and preserving solutions was estimated from a survey of 106 patients undergoing renal transplantation between 1 January 1993 and 31 March 1998. Both efficacy and adverse outcomes were recorded along with the costs directly associated with the transplantation procedure in the hospital setting: hospitalization, rinsing and preserving solutions, medical and technical interventions and diagnostic tests.. For the 45 kidney grafts rinsed and preserved with Eurocollins (strategy S1: n1 = 45) the cost/graft was estimated at 40 euros. With Viaspan (strategy S2: n2 = 61) the corresponding cost/graft was 424 euros. Logistic regression analysis showed that Viaspan was better than Eurocollins solution (ebeta = 0.437; P = 0.05) in preventing DGF. Overall, S2 was less expensive than S1, from the hospital's perspective. The mean difference per patient was 278 euros, which amounts to a saving of 2% of the total cost per renal transplantation. For rinsing and preserving kidney grafts Belzer solution is therefore preferable to Eurocollins solution.

Topics: Adenosine; Allopurinol; Cost Savings; Cost-Benefit Analysis; Glutathione; Graft Survival; Humans; Hypertonic Solutions; Insulin; Kidney; Kidney Transplantation; Kidney Tubular Necrosis, Acute; Organ Preservation; Organ Preservation Solutions; Raffinose; Retrospective Studies

The recent observation that cold storage of kidneys and tubular cells causes marked increase in free radical-catalyzed F2-isoprostanes suggests that radicals might be formed during cold storage. As cold temperature is associated with reduced metabolic and enzymic activity, the notion that cold temperature causes free radical production appeared less tenable. The objective was, therefore, to seek direct evidence for the free radical production during the cold storage of human renal tubular cells, and to define the roles of extrinsic and intrinsic antioxidants in cold-induced cell injury.. Human renal tubular cells were cold-stored at 4 degrees C for varying duration in University of Wisconsin solution and subjected to mRNA analysis, biochemical measurements, and cytoprotective studies.. Cold storage caused a time-dependent reduction in glutathione levels, and an increase in the formation superoxide, hydrogen peroxide, and hydroxyl radicals. Cold-induced lactate dehydrogenase (LDH) release, ATP depletion, DNA damage, and membrane degradation were suppressed with the inclusion of antioxidant 2-methyl aminochroman or deferroxamine. The cells that were structurally protected with antioxidants were also intact functionally, as they had significantly improved cell proliferation. To examine the effect of cold on intrinsic antioxidant gene expression, antioxidant mRNA levels were analyzed using reverse transcription-polymerase chain reaction. The gene expression of mitochondrial Mn-superoxide dismutase (SOD), but not of cytosolic Cu,Zn-SOD or of glutathione peroxidase expression increased with cold exposure. The oxidant-sensitive gene heme oxygenase I increased slightly with 48-hr cold storage.. Cold storage of human tubular cells causes marked increase in free radicals. These are likely of mitochondrial origin as there is a differential inducement of Mn-SOD gene, and are causal to cold-induced cell injury as extrinsic antioxidants abrogated the injury. Our findings support the strategy of adding antioxidants to preservation solutions or the strategy of pre-conditioning the organs to oxidative stress to minimize cold storage-induced organ damage.

Topics: Adenosine; Adenosine Triphosphate; Allopurinol; Antioxidants; Cryopreservation; Gene Expression; Glutathione; Humans; Insulin; Kidney Tubular Necrosis, Acute; L-Lactate Dehydrogenase; Membrane Lipids; Organ Preservation; Organ Preservation Solutions; Raffinose; Superoxides

Topics: Adenosine; Allopurinol; Animals; Catalase; Glutathione; Glutathione Peroxidase; Insulin; Ischemia; Isoenzymes; Kidney; Kidney Tubular Necrosis, Acute; Models, Animal; Organ Preservation; Organ Preservation Solutions; Perfusion; Raffinose; Rats; Rats, Sprague-Dawley; Reperfusion; Superoxide Dismutase; Temperature

Topics: Adenosine; Adenosine Triphosphate; Allopurinol; Animals; Cold Temperature; Glomerular Filtration Rate; Glutathione; In Vitro Techniques; Insulin; Kidney; Kidney Glomerulus; Kidney Tubular Necrosis, Acute; Organ Preservation; Organ Preservation Solutions; Perfusion; Phosphocreatine; Raffinose; Rats; Time Factors

Topics: Adenosine; Adolescent; Adult; Allopurinol; Cadaver; Child; Glutathione; Graft Survival; Humans; Hypertonic Solutions; Insulin; Kidney; Kidney Transplantation; Kidney Tubular Necrosis, Acute; Middle Aged; Organ Preservation Solutions; Postoperative Complications; Potassium; Raffinose; Retrospective Studies; Safety; Statistics, Nonparametric; Tissue Donors

For the storage of human transplanted organs, the benefit of "UW solution" has been proven especially in keeping a longer preservation time for the liver and pancrease; however, the value for kidney preservation was still debated. A total of 293 cases of renal transplantation were performed over 12 years in our hospital and 206 cases were cadaveric transplants. The latter ones were further divided into 3 groups, according to the immunosuppressive medication and preservation solution used. In the CsA treated groups, the ATN rates significantly decreased in those preserved with the UW solution than with the UR solution. Although the UW solution did not improve the graft survival in our series, it did save the cost for postoperative hemodialysis and shorten the hospital stay which made it cost effective.

Topics: Adenosine; Allopurinol; Glutathione; Humans; Hypertonic Solutions; Insulin; Kidney; Kidney Transplantation; Kidney Tubular Necrosis, Acute; Organ Preservation; Organ Preservation Solutions; Postoperative Complications; Raffinose

Experimental preservation time for pulsatile perfused dog kidneys was extended from three to five days by phospholipase A2 inhibition suggesting a pathomechanical role of products of phospholipolysis like thromboxane and leukotrienes in the development of acute graft failure after renal transplantation. We therefore investigated the effects of thromboxane- and leukotriene synthase inhibitors on postoperative renal transplant function in a model of pulsatile perfusion preservation as well as a cold storage preservation of dog kidneys. Addition of a thromboxane-synthase-inhibitor to the perfusion medium in pulsatile perfused kidneys and the combined application of a thromboxane-synthase-inhibitor and a leukotriene-synthase-inhibitor to the recipient of a cold storage preserved graft, improved graft function and reduced the incidence of delayed graft function as well as histopathological features of acute tubular necrosis.

Topics: Adenosine; Allopurinol; Animals; Arachidonic Acid; Aspirin; Benzofurans; Dogs; Enzyme Inhibitors; Female; Glutathione; Ibuprofen; Imidazoles; Insulin; Kidney Transplantation; Kidney Tubular Necrosis, Acute; Kidney Tubules; Leukotriene Antagonists; Leukotrienes; Organ Preservation; Organ Preservation Solutions; Pyridines; Raffinose; Thromboxane-A Synthase

In this study, the ability of low molecular dextrans to prevent morphologically detectable acute tubular necrosis during cold storage was evaluated. Rat kidneys were flushed with a sodium phosphate buffer (pH 7.2) containing different concentrations of dextran 10 (m.w. of 10,000 or less) and stored at 0-2 degrees C for up to 5 days (samples taken at 24-hr intervals). It was found that solutions containing 20% or more of dextran 10 provided significantly improved morphological preservation of kidney nephrons when compared with currently popular kidney cold storage preservation solutions (i.e. University of Wisconsin and Euro-Collins solutions). Adding smaller amounts (i.e., 15%) of dextran 10 to a cold storage solution already containing another effective osmotic agent (i.e., sucrose) also resulted in superior morphological preservation, indicating a beneficial additive effect of using more than one osmotic agent. Dextran 40 (m.w. 40,000) did not provide as good morphological preservation as did a similar concentration of dextran 10. It is concluded that the use of the proper kind and proper amount of low molecular weight dextrans in preservation solutions can significantly reduce the morphologically detectable acute tubular necrosis during cold storage.

Topics: Adenosine; Allopurinol; Animals; Cold Temperature; Dextrans; Glutathione; Hypertonic Solutions; Insulin; Kidney; Kidney Tubular Necrosis, Acute; Male; Organ Preservation; Organ Preservation Solutions; Raffinose; Rats; Rats, Sprague-Dawley

Topics: Adenosine; Allopurinol; Apoptosis; Biopsy, Needle; Cadaver; Epithelium; Family; Glutathione; Graft Rejection; Humans; Insulin; Kidney; Kidney Transplantation; Kidney Tubular Necrosis, Acute; Kidney Tubules; Organ Preservation; Organ Preservation Solutions; Raffinose; Tissue Donors

Topics: Adenosine; Allopurinol; Cadaver; Cyclosporine; Glutathione; Graft Survival; Humans; Hypertonic Solutions; Insulin; Ischemia; Kidney; Kidney Transplantation; Kidney Tubular Necrosis, Acute; Organ Preservation; Organ Preservation Solutions; Raffinose; Time Factors; Tissue Donors

It is known that the earlier the graft begins functioning after cadaver kidney transplantation, the better the graft survival rate and function will be. In order to examine the possibility of shortening the period of acute tubular necrosis (AIN), we retrospectively studied the effect of several factors on the duration of postoperative hemodialysis. The subjects were 27 patients on whom a cadaver kidney transplantation was performed during a 6-year period from July 1, 1986. The mean duration of postoperative hemodialysis was 14.0 days in 26 out of the 27 patients. The remaining patient showed a primary non-functioning kidney. A significant correlation was observed between the anastomosis time and the duration of postoperative hemodialysis. No significant correlations were noted between the duration of postoperative hemodialysis and the age of the donor, renal function during the 24 hours preceding nephrectomy, or cold ischemic time. Moreover, no significant difference was observed in the duration of postoperative hemodialysis between patients using a roller pump for perfusion and patients who did not. The duration of postoperative hemodialysis was significantly shorter in patients using UW solution than in patients using Euro-Collins solution. Graft survival rate 6 months and one year after transplantation was 88.9% and 83.3%, respectively in the EC group, and 100% and 100%, respectively, in the UW group. It was concluded from these results that a short anastomosis time is essential in order to shorten the period of ATN after cadaver kidney transplantation, and that UW solution is effective in shortening the duration of postoperative hemodialysis and improving the graft survival rate thereafter.

Topics: Adenosine; Adolescent; Adult; Aged; Allopurinol; Female; Glutathione; Graft Survival; Humans; Insulin; Kidney Transplantation; Kidney Tubular Necrosis, Acute; Male; Middle Aged; Organ Preservation; Organ Preservation Solutions; Raffinose; Renal Dialysis; Retrospective Studies; Risk Factors

The analyses in this study demonstrated a significant effect of HLA-DR matching on the number of rejection treatments in the first 3 months after renal transplantation.

Topics: Adenosine; Allopurinol; Glucose; Glutathione; Graft Rejection; Histocompatibility Testing; HLA-DR Antigens; Humans; Insulin; Kidney; Kidney Transplantation; Kidney Tubular Necrosis, Acute; Mannitol; Organ Preservation Solutions; Potassium Chloride; Procaine; Raffinose; Time Factors

The incidence of acute tubular necrosis ATN after cadaveric kidney transplantation in our centre has been in the range of 50%. A prospective study was carried out in 1991 and 1992 to assess the effect of in situ perfusion and hypothermic storage of kidneys harvested from brain-dead haemodynamically stable and unstable donors. Three litres of Ringer's solution were used for in situ perfusion. In 40 cases, the kidneys were stored in Euro-Collins (EC) solution and in the other 78 cases, in University of Wisconsin (UW) solution. Among the factors that could contribute to ATN, we analysed warm ischaemia time, anastomosis time and cold storage time. Function was considered to be delayed if the patient required posttransplantation dialysis. The donors were considered haemodynamically unstable when hypotension before harvesting was present (BP < 70 mm Hg over 2 h) despite high doses (> 15 microg/kg per minute) of dopamine or when cardiac arrest occurred at the time of harvesting and oliguria had been present for at least 2 h. Haemodynamically stable donors with a BP greater than 80 mm Hg had a normal diuresis. In all donors in this group the dose of dopamine was lower than 10 microg/kg per minute. The study showed that storage in UW solution did not influence the incidence of ATN in kidneys harvested from haemodynamically unstable donors. Differences observed in our study were due to haemodynamic status preceding donor nephrectomy and length of cold storage time.

Topics: Adenosine; Adult; Allopurinol; Anastomosis, Surgical; Brain Death; Cold Temperature; Glutathione; Hemodynamics; Humans; Hypertonic Solutions; Insulin; Kidney; Kidney Transplantation; Kidney Tubular Necrosis, Acute; Middle Aged; Organ Preservation; Organ Preservation Solutions; Postoperative Complications; Raffinose; Time Factors; Tissue Donors

Topics: Adenosine; Allopurinol; Animals; Blood Urea Nitrogen; Creatinine; Glutathione; Hypertonic Solutions; Insulin; Ischemia; Kidney; Kidney Transplantation; Kidney Tubular Necrosis, Acute; Kidney Tubules, Proximal; Microscopy, Electron; Microvilli; Organ Preservation; Organ Preservation Solutions; Raffinose; Swine; Transplantation, Autologous

Renal vascular resistance was compared in 2 groups of renal grafts: group 1-16 kidneys perfused with University of Wisconsin solution and group 2-16 kidneys perfused with Euro-Collins solution. Both groups had comparable donors and recipient criteria. Renal blood flow was measured by a miniaturized pulsed Doppler probe fixed on the graft renal artery. Renal vascular resistance was calculated either according to the formula: renal vascular resistance (mm. Hg/ml. per second) = systemic arterial pressure (P)/renal blood flow or through the renal vascular resistive index (RVRI): RVRI = systolic flow velocity - diastolic flow velocity/systolic flow velocity = (S-D)/S. Renal vascular resistance estimation seems to be more contributory than renal blood flow in assessment of renal graft reperfusion disorders. Our results show that University of Wisconsin solution seems to preserve intrarenal arterial caliber better with a decrease in intrarenal vascular resistance, thus, allowing for a higher arterial graft perfusion flow.

Topics: Adenosine; Allopurinol; Drug Evaluation; Glutathione; Humans; Hypertonic Solutions; Insulin; Kidney Transplantation; Kidney Tubular Necrosis, Acute; Organ Preservation; Organ Preservation Solutions; Perfusion; Postoperative Period; Raffinose; Renal Artery; Renal Circulation; Solutions; Time Factors; Ultrasonography; Vascular Resistance