title: Protective response in renal transplantation: no clinical or molecular differences between open and laparoscopic donor nephrectomy.
abstract: OBJECTIVE
  Prolonged warm ischemia time and increased intra-abdominal pressure caused by pneumoperitoneum during a laparoscopic donor nephrectomy could enhance renal ischemia reperfusion injury. For this reason, laparoscopic donor nephrectomy may be associated with a slower graft function recovery. However, an adequate protective response may balance the ischemia reperfusion damage. This study investigated whether laparoscopic donor nephrectomy modified the protective response of renal tissue during kidney transplantation.
  
  
  METHODS
  Patients undergoing live renal transplantation were prospectively analyzed and divided into two groups based on the donor nephrectomy approach used: 1) the control group, recipients of open donor nephrectomy (n = 29), and 2) the study group, recipients of laparoscopic donor nephrectomy (n = 26). Graft biopsies were obtained at two time points: T-1 = after warm ischemia time and T+1 = 45 minutes after kidney reperfusion. The samples were analyzed by immunohistochemistry for the Bcl-2 and HO-1 proteins and by real-time polymerase chain reaction for the mRNA expression of Bcl-2, HO-1 and vascular endothelial growth factor.
  
  
  RESULTS
  The area under the curve for creatinine and delayed graft function were similar in both the laparoscopic and open groups. There was no difference in the protective gene expression between the laparoscopic donor nephrectomy and open donor nephrectomy groups. The protein expression of HO-1 and Bcl-2 were similar between the open and laparoscopic groups. Furthermore, the gene expression of B-cell lymphoma 2 correlated with the warm ischemia time in the open group (p = 0.047) and that of vascular endothelial growth factor with the area under the curve for creatinine in the laparoscopic group (p = 0.01).
  
  
  CONCLUSIONS
  The postoperative renal function and protective factor expression were similar between laparoscopic donor nephrectomy and open donor nephrectomy. These findings ensure laparoscopic donor nephrectomy utilization in renal transplantation.
authors.affiliation: Hospital de Caridade, Irmandade Santa Casa de Misericórdia de Curitiba, Division of Urology, Curitiba/PR, Brazil. christianombr@yahoo.com
authors.forename: Christiano
authors.initials: C
authors.lastname: Machado
authors.forename: Denise Maria Avancini Costa
authors.initials: DM
authors.lastname: Malheiros
authors.forename: Ari
authors.initials: A
authors.lastname: Adamy
authors.forename: Luiz Sergio
authors.initials: LS
authors.lastname: Santos
authors.forename: Agenor Ferreira da
authors.initials: AF
authors.lastname: Silva Filho
authors.forename: William Carlos
authors.initials: WC
authors.lastname: Nahas
authors.forename: Francine Brambate Carvalhinho
authors.initials: FB
authors.lastname: Lemos
mesh_terms: D000328:Adult; D003404:Creatinine / Q000097:blood; D051799:Delayed Graft Function / Q000503:physiopathology; D005260:Female; D015870:Gene Expression; D051547:Heme Oxygenase-1 / Q000097:blood; D006801:Humans; D016030:Kidney Transplantation; D010535:Laparoscopy / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011184:Postoperative Period; D060888:Real-Time Polymerase Chain Reaction; D015427:Reperfusion Injury / Q000503:physiopathology; D013997:Time Factors; D020858:Tissue and Organ Harvesting / Q000379:methods*; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000097:blood; D052096:Warm Ischemia / Q000379:methods
chemical_list: D042461:Vascular Endothelial Growth Factor A; D003404:Creatinine; D051547:Heme Oxygenase-1