[Ischemia-reperfusion syndrome and role of preservation graft technique after laparoscopic versus open nephrectomy in a experimental model of living donor kidney transplant].
BACKGROUND
Delayed graft function alter living donor transplantation is a subject of debate. Delayed graft function can be partially explained by renal ischemia-reperfusion injury, when severe is associated with decreased graft survival. In this experimental living donor model study, we analyze the hemodynamic, histological and biochemical effects of laparoscopic nephrectomy. We also, analyze the effect of a pulsatile machine perfusion for kidney preservation during cold ischemia time.


METHODS
Twenty large-white pigs (average weight 40-45 kgrs) were divided in 4 experimental groups: Group A: Laparoscopic nephrectomy+ immediate graft perfusion in pulsatile vacuum pump+autotransplant Group B: Laparoscopic nephrectomy+ immediate graft perfusion by gravity+autotransplant Group C: Open nephrectomy+immediate graft perfusion in pulsatile vacuum pump+autotransplant Group D: Open nephrectomy+ immediate graft perfusion by gravity+autotransplant Both laparoscopic and open nephrectomy were completed transperitoneally according to standardized technique. Hypothermic perfusion was done in a system designed in our lab.


RESULTS
We observed a decreased renal artery flow in kidneys procured laparoscopically compared to open nephrectomy. We found an artery flow recovery during the first 60 minutes after revascularization. Renal machine perfusion during cold ischemia time seems to have no beneficial effect, but shows a deleterious effect on hemodynamic event for renal transplantation. Lower plasma nitric oxide level is observed in kidneys obtained by laparoscopy compared with open surgical technique. And finally, we also found higher histological damage in proximal tubular and endothelial cell, in kidneys obtained by laparoscopy compared with open surgery.


CONCLUSIONS
In our experience: Laparoscopic nephrectomy versus open nephrectomy produces, in a model of living donor transplant, a lower value or renal blood flow and a higher value of renal vascular resistanse. These hemodynamic findings tend to normalize by 60 min after the reperfusion. A lower blood concentration of nitric oxide after the transplant was detected in laparoscopic group Vs open surgery group.
Subirá Ríos
D
D
Servicios de Urología, Medicina y Cirugía Experimental, Hospital General Universitario Gregorio Marañón, Madrid. ibydoc71@hotmail.com
Rodríguez Martínez
D
D
Dulin
E
E
García Bordas
J
J
Alvarez Fernández
E
E
del Cañizo López
J F
JF
Hernández Fernández
C
C
Lledó García
E
E
D000818:Animals; D016030:Kidney Transplantation; D010535:Laparoscopy; D019520:Living Donors; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods*; D009926:Organ Preservation / Q000379:methods*; D015427:Reperfusion Injury / Q000209:etiology*; D013552:Swine