Article

Prognostic significance of free radicals: mediated injury occurring in the kidney donor.

Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland. .
Transplantation (impact factor: 4). 04/2003; 75(8):1221-7. DOI:10.1097/01.TP.0000065282.46425.87
Source: PubMed

ABSTRACT 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.
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.
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).
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.

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Keywords

27 brain-dead organ donors
 
27 donors
 
50 kidney transplant recipients
 
donor TAS activity
 
first week
 
free radical-mediated injury
 
hemodynamic disturbances
 
higher serum MDA
 
Mean ischemia time
 
one dialysis
 
Polish National Waiting
 
Posttransplant
 
posttransplant kidney function
 
posttransplant kidney graft function
 
preservation-solution MDA
 
prospective study
 
Serum creatinine 12
 
systemic circulation
 
total antioxidant status
 
transplantation correlated