RESUMO
Ischemic conditioning involves the delivery of short cycles of reversible ischemic injury in order to induce protection against subsequent more prolonged ischemia. This randomized controlled trial was designed to determine the safety and efficacy of remote ischemic conditioning (RC) in live donor kidney transplantation.This prospective randomized clinical trial, 80 patients undergoing live donor kidney transplantation were randomly assigned in a 1:1 ratio to either RC or to a control group. RC consisted of cycles of lower limb ischemia induced by an arterial tourniquet cuff placed around the patient's thigh. In the RC treatment group, the cuff was inflated to 200 mm Hg or systolic pressure +25 mm Hg for 4 cycles of 5 min ischemia followed by 5 min reperfusion. In the control group, the blood pressure cuff was inflated to 25 mm Hg. Patients and medical staff were blinded to treatment allocation. The primary end-point was renal function measured by estimated glomerular filtration rate (eGFR) at 1 and 3 months posttransplant.Donor and recipient demographics were similar in both groups (Pâ<â0.05). There were no significant differences in eGFR at 1 month (control 52â±â14 vs RC 54â±â17âmL/min; Pâ=â0.686) or 3 months (control 50â±â14 vs RC 49â±â18âmL/min; Pâ=â0.678) between the control and RC treatment groups. The RC technique did not cause any serious adverse effects.RC, using the protocol described here, did not improve renal function after live donor kidney transplantation.
Assuntos
Precondicionamento Isquêmico , Falência Renal Crônica/cirurgia , Transplante de Rim , Condicionamento Pré-Transplante , Adulto , Método Duplo-Cego , Feminino , Taxa de Filtração Glomerular , Humanos , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Calcineurin inhibitors have significant nephrotoxic side effects, which can exacerbate ischemia-reperfusion injury in renal transplantation. Novel therapeutic agents such as hydrogen sulphide (H2S) may reduce these harmful effects. This study investigated the effects of H2S on cyclosporine (CsA) induced nephrotoxicity. MATERIALS AND METHODS: Porcine kidneys were subjected to 15 min of warm ischemia and 2 h of static cold storage. They were reperfused for 3 h with oxygenated normothermic autologous whole blood on an isolated organ reperfusion apparatus. Kidneys were treated with CsA during reperfusion (n = 6) or cyclosporine and 0.25 mmol/L of H2S infused 10 min before and 20 min after reperfusion (n = 6). These were compared with untreated controls (n = 7). RESULTS: CsA caused a significant reduction in renal blood flow during reperfusion, which was reversed by H2S (area under the curve renal blood flow CsA 257 ± 93 versus control 477 ± 206 versus CsA + H2S 478 ± 271 mL/min/100 g.h; P = 0.024). Urine output was higher after 2 h of reperfusion in the CsA + H2S group (CsA + H2S 305 ± 218 versus CsA 78 ± 180 versus control 210 ± 45 mL; P = 0.034). CsA treatment was associated with an increase in tubular injury, which was not reversed by H2S (area under the curve fractional excretion of sodium, control 77 ± 53 versus CsA 100 ± 61 versus CsA + H2S 111 ± 57%.h; P = 0.003). Histologic evaluation showed significant vacuolation and glomerular shrinkage in the CsA group. These were significantly reduced by H2S (P = 0.005, 0.002). CONCLUSIONS: H2S reversed the vasoconstriction changes associated with CsA treatment during reperfusion.
Assuntos
Inibidores de Calcineurina/efeitos adversos , Ciclosporina/efeitos adversos , Sulfeto de Hidrogênio/uso terapêutico , Rim/efeitos dos fármacos , Substâncias Protetoras/uso terapêutico , Traumatismo por Reperfusão/tratamento farmacológico , Animais , Feminino , Sulfeto de Hidrogênio/farmacologia , Rim/irrigação sanguínea , Rim/patologia , Substâncias Protetoras/farmacologia , Suínos , Resultado do Tratamento , Vasoconstrição/efeitos dos fármacos , Isquemia QuenteRESUMO
External iliac artery dissection after kidney transplantation is a rare, catastrophic but potentially reversible complication. Treatment which may save both the transplant and the patient requires clinical suspicion, timely imaging, and prompt intervention. This case report describes successful diagnosis of this complication and surgical intervention which saved the kidney and safeguarded blood supply to the patient's leg.