title: Evidence for protective roles of polyethylene glycol plus high sodium solution and trimetazidine against consequences of renal medulla ischaemia during cold preservation and reperfusion in a pig kidney model.
abstract: BACKGROUND
  The renal medulla is particularly sensitive to oxidant stress and to ischaemia-reperfusion injury (IRI). In organ transplantation, delayed graft function is an important problem and cold ischaemia is thought to be the most important factor in short- and long-term complications. Our aim was to study cold-induced damage in proximal tubular segments and renal medulla osmolite excretion during use of various preservation solutions, and to clarify the role of trimetazidine (TMZ) in limiting renal dysfunction.
  
  
  METHODS
  Using an autotransplanted pig kidney model, we assessed renal tubule function, medullary osmolite excretion and renal damage between day 1 and week 2 after 24 or 48 h cold storage in University of Wisconsin solution (UW), Celsior and ECPEG (two new high Na(+) preservation solutions) or the Hopital Edouard Herriot solution (HEH; a high Na(+) version of UW). In additional groups, TMZ was added to these preservation solutions for 24 and 48 h cold storage.
  
  
  RESULTS
  Renal function was reduced under these preservation conditions. Tubular injury was associated with aminoaciduria and with a limited Na(+) reabsorbtion. Medullary damage led to the early appearance of trimethylamine-N-oxide and dimethylamine in urine. However, renal damage was modulated by preservation conditions. In addition, TMZ added to each of the solutions efficiently protected against IRI even after prolonged preservation.
  
  
  CONCLUSIONS
  TMZ efficiently protected kidneys against damage when added to the HEH and particularly ECPEG solutions, even after 24 h cold storage. These findings point to a role for drugs that target mitochondria, and demonstrate that TMZ may provide a valuable therapeutic tool against IRI and could be included in therapeutic protocols.
authors.affiliation: INSERM ERM Poitiers, Département de Génétique Animale, Hôpital Jean Bernard, Poitiers, France.
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Faure
authors.forename: Christophe
authors.initials: C
authors.lastname: Jayle
authors.forename: Delphine
authors.initials: D
authors.lastname: Dutheil
authors.forename: Michel
authors.initials: M
authors.lastname: Eugene
authors.forename: Keqiang
authors.initials: K
authors.lastname: Zhang
authors.forename: Jean Michel
authors.initials: JM
authors.lastname: Goujon
authors.forename: Isabelle
authors.initials: I
authors.lastname: Petit-Paris
authors.forename: Jean Paul
authors.initials: JP
authors.lastname: Tillement
authors.forename: Guy
authors.initials: G
authors.lastname: Touchard
authors.forename: Rene
authors.initials: R
authors.lastname: Robert
authors.forename: Anne
authors.initials: A
authors.lastname: Wahl
authors.forename: Francois
authors.initials: F
authors.lastname: Seguin
authors.forename: Gerard
authors.initials: G
authors.lastname: Mauco
authors.forename: Alain
authors.initials: A
authors.lastname: Vandewalle
authors.forename: Thierry
authors.initials: T
authors.lastname: Hauet
mesh_terms: D000818:Animals; D003080:Cold Temperature; D007668:Kidney / Q000473:pathology / Q000502:physiology; D007679:Kidney Medulla / Q000098:blood supply*; D009926:Organ Preservation / Q000009:adverse effects*; D019188:Organ Preservation Solutions / Q000494:pharmacology*; D011092:Polyethylene Glycols / Q000494:pharmacology*; D015427:Reperfusion Injury / Q000209:etiology* / Q000517:prevention & control*; D012965:Sodium Chloride / Q000494:pharmacology*; D013552:Swine; D013997:Time Factors; D014292:Trimetazidine / Q000494:pharmacology*
chemical_list: D019188:Organ Preservation Solutions; D011092:Polyethylene Glycols; D012965:Sodium Chloride; D014292:Trimetazidine