RESUMEN
Public attitude toward deceased donor organ recovery in Poland is quite positive, with only 15% opposing to donation of their own organs, yet actual donation rate is only 16/pmp. Moreover, donation rate varies greatly (from 5 to 28 pmp) in different regions of the country. To identify the barriers of organ donation, we surveyed 587 physicians involved in brain death diagnosis from regions with low (LDR) and high donation rates (HDR). Physicians from LDR were twice more reluctant to start diagnostic procedure when clinical signs of brain death were present (14% versus 5.5% physicians from HDR who would not diagnose death, resp.). Twenty-five percent of LDR physicians (as opposed to 12% of physicians from HDR) would either continue with intensive therapy or confirm brain death and limit to the so-called minimal therapy. Only 32% of LDR physicians would proceed with brain death diagnosis regardless of organ donation, compared to 67% in HDR. When donation was not an option, mechanical ventilation would be continued more often in LDR regions (43% versus 26.7%; P < 0.01). In conclusion, low donation activity seems to be mostly due to medical staff attitude.
RESUMEN
Results of kidney transplantation are excellent, but the number of patients on the waiting lists far exceeds the number of available organs. Living kidney donation must be considered as an important part of organ transplantation programmes. In the European Union countries, nearly 20% of all kidney transplants in 2010 were done with organs from living donors. However, the proportion of live donor kidney transplantation between EU countries varies greatly: from 3% to 54% of all kidney transplantations. Multiple initiatives have been undertaken in most of the European countries to increase the number of living donor kidney transplantations. In some countries widening of the donor pool has nearly reached the limits by accepting altruistic donors, paired and group exchanges, and even by performing live donor kidney transplantation in highly immunized recipients. There is a great need to optimize living donor kidney transplantation programmes by using a new strategy of: a. Detailed and adequate medical and psychosocial evaluation, ensuring that the need to increase programme activity will not overshadow the most important principle--donor safety. b. Total removal of all disincentives and financial obstacles that discourage potential donors, and provision of financial coverage for the follow-up. c. Sufficient detailed information about the option of living donor kidney transplantation, its results, and donor safety, delivered to relatives of patients with end-stage renal disease and to the patients themselves.
Asunto(s)
Trasplante de Riñón , Donadores Vivos , Seguridad , Obtención de Tejidos y Órganos , HumanosRESUMEN
The excellent results of vascularized organ transplantation have resulted in an increasing number of end-stage organ failure patients seeking such treatment. The results of organ transplantation depend on a number of factors--the quality of the donor (and an organ), living vs. deceased donation, magnitude of ischemic injury (and its prevention), and recipient-dependent factors. Ischemia/reperfusion injury in organ transplantation is a multifactorial process, which may lead to delayed graft function. In addition, surgical and preservation techniques, type of immunosuppressive regimens, complications after transplantation and post-transplant management may also have a significant impact on short- and long-term results of transplantation. In this paper we describe advances in transplantation in recent years, with particular emphasis on kidney, liver, intestines, whole pancreas and pancreatic islets.
Asunto(s)
Abdomen/patología , Trasplante de Órganos/tendencias , Medicamentos Genéricos/uso terapéutico , Humanos , Terapia de Inmunosupresión , Inmunosupresores/uso terapéutico , Donantes de TejidosRESUMEN
BACKGROUND: The study comprises an analysis of bacterial infections in the early period after liver transplantation (LT) in adults. MATERIAL/METHODS: Eighty-three patients were followed for four weeks after LT. Samples comprised mainly blood, urine, surgical-site specimens, sputum, and stool. Culture and identification of the isolated microorganisms was done in accordance with standard microbiological procedures. Susceptibility testing was carried out using CLSI guidelines. Statistical analysis was done with Medi-Stat. RESULTS: In total, 913 samples from LT recipients were cultured. Of the 469 isolated strains, 331 (70.6%) were Gram-positive bacteria, 133 (28.4%) were Gram-negative bacteria, and 5 (1.0%) were yeast-like fungal strains. Of the 284 surgical-site isolates, 222 (78%) were Gram-positive and 61 (21.5%) were Gram-negative bacteria. Of the 99 blood culture isolates, 75 (75.8%) were Gram-positive and 22 (22.2%) of Gram-negative bacterial strains. Of the 73 urine samples, 46 (63.0%) were strains of Gram-negative, 25 (34.0%) of Gram-positive bacteria, and 2 (3.0%) fungal strains. In the 13 respiratory tract samples were 9 (69.0%) Gram-positive and 4 (31.0%) Gram-negative strains. In the 54 stool samples, 63.0% and 16.7% were C. difficile toxin- and culture-positive, respectively. In total, 138 strains of MRCNS, 10 of MRSA, 80 of HLAR, and 19 ESBL(+) were detected. CONCLUSIONS: The isolation of MDR bacterial strains such as MRSA (52.6%), MRCNS (81.7%), HLAR (86.0%), and ESBL(+) Gram-negative rods (12.5%) from patients after LT indicates the need for strict adherence to infection control procedures.
Asunto(s)
Infecciones Bacterianas/etiología , Trasplante de Hígado/efectos adversos , Complicaciones Posoperatorias/etiología , Adolescente , Adulto , Anciano , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/microbiología , Femenino , Hongos/efectos de los fármacos , Hongos/aislamiento & purificación , Bacterias Gramnegativas/efectos de los fármacos , Bacterias Gramnegativas/aislamiento & purificación , Bacterias Grampositivas/efectos de los fármacos , Bacterias Grampositivas/aislamiento & purificación , Humanos , Control de Infecciones , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Polonia , Complicaciones Posoperatorias/tratamiento farmacológico , Complicaciones Posoperatorias/microbiología , Estudios Prospectivos , Infección de la Herida Quirúrgica/tratamiento farmacológico , Infección de la Herida Quirúrgica/etiología , Infección de la Herida Quirúrgica/microbiología , Factores de Tiempo , Adulto JovenRESUMEN
BACKGROUND: Despite documented positive effect of MachinePerfusion (MP) on long-term kidneys-graft function its wide use is restricted due to higher costs. The aim of this study was to analyze the difference in costs of kidney transplantation in patients who received organ stored in ColdStorage (CS) vs those who received kidneys stored with MP.
MATERIAL/METHODS: Analysis was done on kidney transplantations performed between 1994-1999 in 415 patients.. Kidneys were not randomized to MP or to CS: 188 kidneys were stored in CS, 227-in MP. Recipients didn't differ in regard to the age, sex, PRA, HLA mismatch, and immunosupression.The costs of organ procurement,transportation,surgical and anesthetic procedures, episodes of acute rejection were similar for both group of patients and were not included into the analysis. Costs of first month post-transplantation included: the cost of MP, post-transplantation hemodialysis, costs of hospitalization.Analysis of costs difference in between two groups of patients during follow-up included the costs of immunosupression and the monthly cost of dialysis. Statistical analysis was done using linear regression model.
RESULTS: Long graft survival was 68,2% in MP group vs.54,2% in CS group (p=0.02) Return to dialysis treatment was 20% in MP group vs.36% in CS group (p=0.01).Since 2 month post-transplant, mean cost of treatment for one patient was higher of 59,7 USD in CS group vs. MP group (p<0.001)in each month. Costs of investments on MP were equalized in 16 month post-transplantation.
CONCLUSIONS: Despite higher costs of MP use in the first month post transplantation, it is money-saving method of kidneys preservation and its cost of use, are equalized after 16 months post transplantation.
Asunto(s)
Criopreservación , Trasplante de Riñón/economía , Preservación de Órganos/métodos , Criopreservación/economía , Supervivencia de Injerto , Hospitalización/economía , Humanos , Riñón , Fallo Renal Crónico/cirugía , Preservación de Órganos/economía , Polonia , Diálisis Renal/economía , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: Cold storage (CS) of cadaveric kidneys procured from hemodynamically stable donors for less than 24 hours is a safe procedure. Some papers indicate that continuous pulsatile machine perfusion (MP) allows for extension of preservation times, permits a wider use of kidneys damaged by preagonal ischemia, results in superior immediate function rate as compared to CS and improves long-term graft survival. The aim of the study was to evaluate the influence of kidney preservation method prior to transplantation on the characteristics of histopathological lesions of allografts at long-term post transplantation. MATERIAL/METHODS: The study group consisted of 274 patients who received a cadaveric kidney allograft between 1994 and 1999. Altogether 553 biopsy specimens were obtained from this group of patients between 1994 and 2004 and graded according to Banff 2005 criteria.Two groups were identified: CS - recipients of kidneys stored in simple hypothermia (n=114) and MP - recipients of kidneys stored by machine perfusion (n=160). There were 161 cadaveric donors, 92 in the Mp group and 69 in the CS group. The 553 biopsy specimens obtained revealed the following: interstitial fibrosis and tubular atrophy - 189, chronic rejection - 19, acute rejection - 64, arteriosclerosis - 117, calcineurin inhibitor toxicity - 25, microangiopathy - 44, focal glomerulosclerosis - 82, arteriole hyalinization - 85, ATN - 241. RESULTS: In the CS group histopathological lesions consistent with interstitial fibrosis and tubular atrophy were more frequently encountered than in the MP group (90% vs 64%, p<0.05) Also, chronic rejection was more frequent in the CS group (9% vs 3%, p<0.05). The remaining lesions encountered in biopsies did not differ significantly between the groups. CONCLUSIONS: Kidneys preserved by cold storage are more frequently affected by chronic rejection and interstitial fibrosis.
Asunto(s)
Criopreservación , Trasplante de Riñón , Preservación de Órganos , Adulto , Femenino , Fibrosis , Rechazo de Injerto/epidemiología , Humanos , Riñón/patología , Trasplante de Riñón/inmunología , Trasplante de Riñón/patología , Masculino , Persona de Mediana Edad , Factores de Riesgo , Trasplante HomólogoRESUMEN
BACKGROUND: A prospective evaluation of the influence of methods of kidney storage prior to transplantation on long-term graft function has not been shown so far. A retrospective study undertaken in 415 patients in our department showed the benefit of machine perfusion (MP) on long-term results. The aim of the present study was to assess prospectively the long term function and survival of paired kidney allografts retrieved from the same donor, comparing the influence of cold storage (CS) and MP. MATERIAL/METHODS: 74 recipients included in the study received kidneys from 37 cadaveric donors. Kidneys were randomized to storage by CS or MP. There were no significant differences between the groups as to age, gender, duration of ESRD treatment, PRA titres, HLA compatibility and immunosuppressive regimens. RESULTS: At 10 years follow-up recipients of CS-stored kidneys returned to dialysis treatment twice as frequently as recipients of MP-stored kidneys (50% vs. 25%, p=0.02). CONCLUSIONS: Kidney storage by MP improves graft survival and reduces the number of patients who return to dialysis treatment at long-term post-transplant.
Asunto(s)
Funcionamiento Retardado del Injerto/epidemiología , Trasplante de Riñón , Adolescente , Adulto , Anciano , Niño , Preescolar , Criopreservación , Femenino , Supervivencia de Injerto , Humanos , Hipotermia , Fallo Renal Crónico/cirugía , Trasplante de Riñón/patología , Trasplante de Riñón/fisiología , Masculino , Persona de Mediana Edad , Preservación de Órganos/métodos , Perfusión , Estudios Prospectivos , Flujo Pulsátil , Diálisis Renal , Trasplante Homólogo , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Various preparations of ALG/ATG have been used in clinical transplantation for more than 30 years. In recent years the number of high immunological risk patients has increased and biological agents are being used as induction therapy. The aim of this prospective, randomized study was to asses the safety and efficacy of a single high dose of antithymocyte globulin (9 mg/kg ATG Fresenius S) in cadaveric renal transplantation. The maintenance immunosuppressive regimen consisted of steroids, mycophenolate mofetil (converted after the fourth month to azathioprine), and cyclosporine. MATERIAL/METHODS: Between November 1997 and April 1999, 79 recipients were included into the study. Patients were randomized to ATG (n=40) or the standard treatment group (n=39) with a follow up period of 5 years. RESULTS: The incidence of acute rejection was lower in the ATG group--9 patients (22.5%) compared to 14 in the control group (35.9%) (p=NS). The total number of all acute rejections episodes in the ATG group was 11 and 23 in the control group. Steroid resistant rejections occurred in 4 (10%) and 8 (20.5%) patients respectively. The number of infectious complications was similar in both groups (65% - ATG, 67.5% - control, p=NS). Graft survival was 70% for the ATG and 69.23% for the control group. Death censored graft survival was 85% in the ATG and 74.43% in the control group (p=NS). CONCLUSIONS: Induction Therapy with high single dose of ATG seems to be safe and efficacious in kidney transplantation.
Asunto(s)
Suero Antilinfocítico/uso terapéutico , Trasplante de Riñón/fisiología , Corticoesteroides/uso terapéutico , Adulto , Quimioterapia Combinada , Femenino , Rechazo de Injerto/epidemiología , Humanos , Inmunosupresores/uso terapéutico , Tiempo de Internación , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/clasificación , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Seguridad , Resultado del TratamientoRESUMEN
Organ transplantation has become very successful method of treatment of end stage organ disease. However the waiting lists of patients aiming such treatment are exponentially growing due to insufficient organ supply. Prognosis of the future for transplantation medicine is truly difficult. Prospects from past years, that "soon induction of tolerance will become possible"(1975), wide xenogenic transplant utilization (in 2000), fetal brain cell transplantation to treat some neurologic disease and transplantation of isolated cells instead of whole organs (1998) proved wrong. The research in the nearest future will be focused on tolerance induction, inhibition of alloreaction in blood-group discordant transplants (in immunized patients) and xenografts. In parallel, studies on hybrid and totally artificial, implantable devices (artificial pancreas and liver) will be carried on. 21st century will belong to regeneration medicine, with therapeutic applications of stem cells.
Asunto(s)
Trasplante de Órganos/tendencias , Trasplante Heterólogo/tendencias , Predicción , Humanos , Células Madre/inmunología , Células Madre/fisiología , Ingeniería de Tejidos/tendencias , Obtención de Tejidos y Órganos/organización & administración , Obtención de Tejidos y Órganos/estadística & datos numéricosRESUMEN
BACKGROUND: We designed a study with the following aims: to assess tissue quality of 100 cadaveric livers discarded from transplantation, to identify discarded organs which could have been used either for transplantation or for isolation of hepatocytes, to assess donor clinical factors which may impact the histology. MATERIAL/METHODS: Liver wedge biopsies were performed during kidney procurement, sent for processing and data interpretation. RESULTS: In 46% of the evaluated tissues severe changes were found; these organs according to pathologists were "not suitable for transplantation". In 19% less pronounced changes classified organs as "probably not suitable for transplantation". In 35% biopsies only minimal changes were found; these organs were classified as "probably suitable for transplantation" and could have been harvested as marginal organs or at least used for hepatocytes isolation. CONCLUSIONS: Results of biopsies suggested that approximately in one third of livers discarded from transplantation due to clinical donor parameters could have been harvested from histological point of view. Several donor clinical risk factors (alcohol addiction, hyperbilirubinemia, increased transaminase activity) correlate with severe histological changes rending the liver "not suitable for transplantation".
Asunto(s)
Trasplante de Hígado , Hígado/patología , Donantes de Tejidos , Obtención de Tejidos y Órganos/normas , Trasplantes/normas , Adolescente , Adulto , Anciano , Biopsia , Cadáver , Separación Celular , Niño , Preescolar , Contraindicaciones , Hepatocitos/citología , Humanos , Lactante , Persona de Mediana Edad , Factores de RiesgoRESUMEN
New medical technologies are products of human mind and the result of development in the field of diagnostic techniques, pharmacotherapy and biotechnology. Transplantation medicine, which is also a new medical technology, differs from the others in that it requires a living organ obtained from a dead person or a living donor. Development of market economy and globalization have made the new technologies available almost in every country. Along with them some expectations have come up among the societies, that what is possible--soon will be available. This applies also to transplantation medicine. However, its availability is restricted by flawed or misinterpreted regulations, ethical and social barriers, and financial potential. Transplantation process depends enormously on economical conditions and attitude of both the society, and the medical profession.
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Trasplante de Órganos/ética , Trasplante de Órganos/legislación & jurisprudencia , Condiciones Sociales , Bioética/tendencias , Comercio/ética , Humanos , Ciencia del Laboratorio Clínico/tendencias , Trasplante de Órganos/economía , Polonia , Donantes de Tejidos/ética , Donantes de Tejidos/provisión & distribuciónRESUMEN
The authors present current status of liver transplantation (LTx) in Poland. Till 2004, 845 LTx were performed: 604 in adults and 241 in children; 71 of them were the living donor LTx. Post-inflammatory cirrhosis in adults and biliary atresia in children were the most common indications for LTx. The results of LTx in Poland are good and comparable with the results published by other centers. The number of available cadaveric grafts is growing and in 2004 achieved an index of harvesting as high as 14,7 per million people.
Asunto(s)
Hepatopatías/cirugía , Trasplante de Hígado/métodos , Trasplante de Hígado/estadística & datos numéricos , Donantes de Tejidos/estadística & datos numéricos , Adulto , Atresia Biliar/cirugía , Cadáver , Niño , Fibrosis/cirugía , Humanos , Hepatopatías/epidemiología , Donadores Vivos , Polonia/epidemiología , Donantes de Tejidos/provisión & distribución , Conservación de Tejido/métodos , Resultado del TratamientoRESUMEN
Juvenile rheumatoid arthritis (JRA) is an immune-mediated disease characterized by articular inflammation and subsequent tissue damage that may result in severe disability. Several combinations of drugs, including immunosuppressive agents have been used to control disease progression. Although there is no information available on rapamycin efficacy in JRA, it has demonstrated a potential to inhibit inflammatory processes observed in adult rheumatoid arthritis (RA). We present a 21 years old renal transplant recipient with JRA, primarily treated with tacrolimus and steroids, who achieved a long-term disease remission after introduction of rapamycin. As long as pathogenesis of JRA and RA is similar, we conclude that rapamycin could be promising immunosuppressant for patients after renal transplantation suffering from both JRA and RA.
Asunto(s)
Artritis Juvenil/tratamiento farmacológico , Inmunosupresores/uso terapéutico , Sirolimus/uso terapéutico , Adulto , Humanos , Trasplante de Riñón , MasculinoRESUMEN
The Warsaw Transplant Center comprises 3 programs for transplantation of kidney, pancreas and liver. At the end of 2005, 3,616 kidney, 131 simultaneous pancreas kidney and 592 liver transplants had been performed. The one-year patient and graft survival rates were 92.8% and 91.1%, respectively, for 2,689 kidney transplants performed in 2001-2003 and the 5-year patient and graft survival rates were 91.4% and 77.1%, respectively, for 1,667 transplants performed in 1998-2001. The number of liver transplantations performed at the Medical University of Warsaw is growing. The gender distribution is well balanced and the most common age of the transplant recipients ranges from 41-50 years. The most common indications were post-hepatitis C and B cirrhosis and post-alcoholic cirrhosis. The average one-year mortality after liver transplantation was 9.8%. The results of liver transplantations at the Medical University of Warsaw are similar to those reported by other leading European centers. At present, 495 patients are alive with good liver function 1-8 years after transplantation.
Asunto(s)
Trasplante de Órganos/estadística & datos numéricos , Supervivencia de Injerto , Hospitales Universitarios/estadística & datos numéricos , Humanos , Terapia de Inmunosupresión/métodos , Trasplante de Riñón/inmunología , Trasplante de Riñón/estadística & datos numéricos , Trasplante de Hígado/inmunología , Trasplante de Hígado/estadística & datos numéricos , Donadores Vivos , Trasplante de Órganos/mortalidad , Trasplante de Páncreas/inmunología , Trasplante de Páncreas/estadística & datos numéricos , Polonia , Estudios Retrospectivos , Análisis de Supervivencia , Donantes de Tejidos , Inmunología del TrasplanteRESUMEN
Liver graft function after transplantation is dependent on ischemia-reperfusion injury, toxicity of drugs (immunosuppression, antibiotics and other) and transplant rejection. Although routinely monitored with enzymatic tests (AST, ALT, GGT, ALP), bilirubin and coagulation parameters, differentiation between these pathologies is hardly possible without liver biopsy. Arginase (3.5.3.1) mostly exists in the liver and in trace amounts in extra-hepatic tissue. Thus, we hypothesized that activity of arginase could be a more specific test of liver function. Sera of 32 liver transplant recipients were tested for AST, ALT, ATIII, bilirubin and arginase. Samples were obtained daily in first 2 weeks after LTx and weekly afterwards. Correlation of arginase activity with other liver function markers was calculated. Serum arginase peaked at day 1 post LTx (mean 64,6+/-91 IU/L), and decreased more rapidly than other tests if good liver function was observed. The values showed strong and significant correlation with AST and ALT activities (Pearsons R 0,65 and 0,47 respectively). We conclude that activity of arginase in the serum is an exact test of liver function.
Asunto(s)
Arginasa/sangre , Pruebas de Función Hepática , Trasplante de Hígado , Hígado/fisiopatología , Adulto , Alanina Transaminasa/sangre , Aspartato Aminotransferasas/sangre , Biomarcadores/sangre , Femenino , Humanos , Masculino , Persona de Mediana Edad , Periodo PosoperatorioRESUMEN
OBJECTIVES: Brain stem death results in ischemic damage of organs. To prevent many agents are being tested this damage. The aim of our study was to determine effects of sulforaphane (SF) on recovery, viability, lipid peroxidation, metabolic and endocrine function of islets isolated from rat pancreata and treated with warm and/or cold ischemia and then transplanted syngeneically. METHODS: Rat pancreata were recovered from non-heart beating rats after intraducatal injection of collagenase solution after 15 or 30 minutes of warm ischemia time (WT). Cold ischemia (CT) was obtained by storage of distended and harvested glands in tubes with UW solution in 4 degrees C for 120 minutes. Sulforaphane was administered 24 hours before isolation islets in concentration 24mg/kg b.w. Diabetes was achieved by intravenouse injection of streptozotocin (STZ 65mg/kg b.w.). Islets were transplanted into the liver through the portal vein. Experimental protocol included four groups: Group I: fresh pancreata not treated with SF, WT=0, CT=0; Group II: 15 or 30 min. of WT, with or without SF; Group III: 15 or 30 min. of WT and 120 min. of CT, with or without SF; Group IV: 120 min. of CT, with or without SF RESULTS: Stimulation index in all groups with sulforaphane was larger from 1.0 (normal response of islets on high concentration glucose in medium). Metabolic activity (MTT) in group II (WT15, SF), gr. IV (CT, SF) and in gr. III (WT15, CT, SF; p>0.05) was lower compared to control group (I). The concentration of MDA in groups with SF increased as compared to controls. The highest recovery and cell viability was observed in group IV (CT, SF) and in gr. III (WT15, CT, SF; p<0.05). In groups exposed to 30 min. of warm ischemia and/or 120 min. of cold preservation was observed higher % of dead islets cells. In vivo study shows that islets graft isolated from rat pancreata treated with sulforaphane reverse diabetes. CONCLUSIONS: Based on results we can conclude that SF in concentration 24mg/kg b.w. reveals protective effect on preserved pancreas and may have a potential clinical implication to improve hemodynamically unstable pancreas donor condition.
Asunto(s)
Criopreservación , Depuradores de Radicales Libres/farmacología , Supervivencia de Injerto/efectos de los fármacos , Trasplante de Islotes Pancreáticos , Islotes Pancreáticos/efectos de los fármacos , Preservación de Órganos/métodos , Tiocianatos/farmacología , Animales , Citoprotección , Diabetes Mellitus Experimental/fisiopatología , Diabetes Mellitus Experimental/cirugía , Islotes Pancreáticos/fisiopatología , Isotiocianatos , Hígado/cirugía , Ratas , Ratas Endogámicas , Sulfóxidos , Factores de Tiempo , Trasplante HeterotópicoRESUMEN
Isothiocyanates are a group of naturally occurring compounds with interesting medical properties, such as antimicrobial, antioxidant and antitumor activities. In our work we were trying to present the tumoricidal activity of new synthesized derivatives of one isothiocyanate: 1-isothio-cyanato-(4R)-(methylsulfinyl) butane [sulforaphane]. Many chemical substances derived from plants, undoubtedly have protective properties. The effectiveness of sulforaphane is based on induction of hepatic detoxifying enzymes.
Asunto(s)
Anticarcinógenos/farmacología , Neoplasias/prevención & control , Tiocianatos/farmacología , Animales , Antioxidantes/química , Glutatión/metabolismo , Hemo Oxigenasa (Desciclizante)/metabolismo , Humanos , Isotiocianatos , Neoplasias/genética , Neoplasias/patología , Sulfóxidos , Tiocianatos/química , Tiocianatos/aislamiento & purificaciónRESUMEN
BACKGROUND: Brain death is associated with hemodynamic disturbances in systemic circulation and metabolic storm, and, thus, free radical-mediated injury to donor tissues was hypothesized. An assessment of oxidative stress in the donor and its effect on posttransplant kidney graft function comprised the scope of the study. METHODS: A prospective study was performed in 27 donors and 50 kidney transplant recipients. Sera from 27 brain-dead organ donors and preservation media were tested for malondialdehyde (MDA) and for total antioxidant status (TAS). Kidneys were preserved in University of Wisconsin-gluconate solution with machine perfusion. Mean ischemia time was 36.7+/-8 hours. Organs were transplanted to recipients on the Polish National Waiting List and posttransplant kidney function was monitored periodically. Posttransplant delayed graft function (DF) was diagnosed when a patient required at least one dialysis within first week after transplantation. Acute rejection was diagnosed clinically and confirmed with fine-needle biopsy if necessary. RESULTS: Thirty-two recipients had immediate graft function (IF), and 18 suffered from DF. MDA level in preservation solution at the end of machine perfusion was significantly higher in the DF group (52.6+/-31 vs. 25.3+/-19 micromol/L) whereas donor TAS activity was lower (1.14+/-0.2 vs. 0.97+/-0.3 mmol/mL). Patients who suffered from acute rejection received kidneys from donors with significantly higher serum MDA (66+/-73 micromol/ml vs. 23+/-49 for patients without rejection). Serum creatinine 12 to 48 months after transplantation correlated to donor- and preservation-solution MDA (P<0.006). CONCLUSIONS: Free-radical mediated injury occurring in the donor and during preservation is strictly correlated with immediate and long-term kidney function. It may also cause grafts to be prone to acute rejection.