Protective effect of low serum thyroid hormone concentration on occurrence of functional delayed kidney allograft function early after transplantation.

BACKGROUND: Thyroid hormones affect the functioning of a number of organs and may alter kidney function. In contrast, the thyroid gland may be influenced by renal dysfunction. The present study evaluated triiodothyronine (T3), thyroxine, and thyroid-stimulating hormone concentrations before and early after transplantation relative to the occurrence of delayed graft function. PATIENTS AND METHODS: Eighty-seven consecutive patients (52 male and 37 female patients) undergoing kidney transplantation were entered in this cross-sectional study, and T3, thyroxine, and thyroid-stimulating hormone concentrations were measured on the day before transplantation and on days 1, 3, and 7 after engraftment. RESULTS: The mean (SD) serum T3 concentration was significantly greater before transplantation in patients with delayed graft function compared with those with normally functioning kidney allografts (129±31.44 ng/dL versus 102±36.77 ng/dL; P-value=.048). Lower T3 concentration values were predictive of delayed graft function. It was hypothesized that early after transplantation, in patients with uremia, a low T3 concentration confers a protective effect against ischemia-reperfusion injury, mitigating a hypercatabolic state. CONCLUSION: Low serum T3 concentration in patients with uremia before transplantation may have protective effects against the hypercatabolic uremic state and ischemia-reperfusion injury early after engraftment.

Insulin resistance and insulin secretion changes in kidney transplant recipients with normal graft function compared with those with delayed graft function early after transplantation.

INTRODUCTION: We compared insulin resistance (IR) and insulin secretion (IS) among kidney transplant recipients with normal versus delayed graft function (DGF) early after transplantation. METHODS: We selected 55 kidney transplant recipients without a history of clinical diabetes mellitus. The basal values of glucose (G) and insulin (I) were used to calculate indices of IR and IS before, on the third day, as well as at the end of the first, second, and third weeks after transplantation. RESULTS: Before transplantation IR was more prevalent (62.5%) than impaired IS (20%; P = .012). Three weeks after engraftment, IR was significantly reduced (P < .001), whereas the reduction in the IS was not significant (P = .17). Splitting the results between normal and delayed functioning grafts showed a significant difference in both IR and IS between the 2 groups on the third day after transplantation (P = .018 and .024, respectively). Regression models showed that only cumulative administered cyclosporine dose and plasma creatinine were significantly (or near significantly) associated with IR (P = .04 and .07, respectively). CONCLUSION: Among patients with DGF there was a significantly greater prevalence of IR and IS compared with successfully engrafted patients in the middle of the first week after transplantation. With resumption of normal kidney function among the DGF group, this difference disappeared at the end of the third week after transplantation.