The influence of warm ischemia elimination on kidney injury during transplantation - clinical and molecular study.
Kidney surface cooling was used during implantation to assess the effect of warm ischemia elimination on allograft function, histological changes and immune-related gene expression. 23 recipients were randomly assigned to a group operated on with kidney surface cooling during implantation (ice bag technique, IBT group), and the other 23 recipients receiving the contralateral kidney from the same donor were operated on with a standard technique. Three consecutive kidney core biopsies were obtained during the transplantation procedure: after organ recovery, after cold ischemia and after reperfusion. Gene expression levels were determined using low-density arrays (Format 32, TaqMan). The IBT group showed a significantly lower rate of detrimental events (delayed graft function and/or acute rejection, p = 0.015) as well as higher glomerular filtration rate on day 14 (p = 0.026). A greater decrease of MMP9 and LCN2 gene expression was seen in the IBT group during total ischemia (p = 0.003 and p = 0.018). Elimination of second warm ischemia reduced the number of detrimental events after kidney transplantation, and thus had influence on the short-term but not long-term allograft function. Surface cooling of the kidney during vascular anastomosis may reduce some detrimental effects of immune activation resulting from both brain death and ischemia-reperfusion injury.
Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław 50-556, Poland.
Dorota
D
Kamińska
Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław 50-556, Poland.
Katarzyna
K
Kościelska-Kasprzak
Department of General, Vascular and Transplant Surgery, Wroclaw Medical University, Wrocław 50-556, Poland.
Paweł
P
Chudoba
Department of Pathomorphology and Oncological Cytology, Wroclaw Medical University, Wrocław 50-556, Poland.
Agnieszka
A
Hałoń
Faculty of Medicine and Dentistry, Wroclaw Medical University, Wrocław 50-556, Poland.
Oktawia
O
Mazanowska
Department of Histology and Embryology, Wroclaw Medical University, 50-368, Wrocław, Poland.
Agnieszka
A
Gomółkiewicz
Department of Histology and Embryology, Wroclaw Medical University, 50-368, Wrocław, Poland.
Piotr
P
Dzięgiel
Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław 50-556, Poland.
Dominika
D
Drulis-Fajdasz
Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław 50-556, Poland.
Marta
M
Myszka
Department of General, Vascular and Transplant Surgery, Wroclaw Medical University, Wrocław 50-556, Poland.
Agnieszka
A
Lepiesza
Department of Surgery, Division of HPB and Transplantation Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Wojciech
W
Polak
Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław 50-556, Poland.
Maria
M
Boratyńska
Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław 50-556, Poland.
Marian
M
Klinger
D000328:Adult; D000368:Aged; D064591:Allografts / Q000473:pathology; D005260:Female; D005786:Gene Expression Regulation; D006801:Humans; D007150:Immunohistochemistry; D007668:Kidney / Q000293:injuries* / Q000473:pathology; D016030:Kidney Transplantation; D000071068:Lipocalin-2 / Q000235:genetics / Q000378:metabolism; D008297:Male; D020780:Matrix Metalloproteinase 9 / Q000378:metabolism; D008875:Middle Aged; D015999:Multivariate Analysis; D014019:Tissue Donors; D052096:Warm Ischemia; D055815:Young Adult
C489506:LCN2 protein, human; D000071068:Lipocalin-2; D020780:Matrix Metalloproteinase 9