Ascorbic acid against reperfusion injury in human renal transplantation

Abstract

The cadaveric renal graft is exposed to ischaemic injury during preservation and to oxidative damage during reperfusion. Both these mechanisms are known to cause cell damage, which may impair graft function. Reperfusion injury (RPI) is mediated by reactive oxygen species (ROS). Ascorbic acid (AA) is a potent physiological extracellular scavenger of ROS. We perfused 31 renal grafts immediately before implantation with a solution of Euro-Collins containing 0.5 mg/ml of AA to diminish RPI. From every donor, the contralateral kidney served as a control. The control grafts were perfused with the same perfusion as those of the AA group, only without the AA substitution. We assessed the effect of AA by recording serum creatinine, creatinine clearance, initial graft function and early rejections. The incidence of delayed graft function (DGF) was 32% in the AA group, and 29% in the control group. Other parameters were also similar in both groups, except for the length of DGF, which showed a trend towards a shorter duration in the AA group. The pre-operative systemic AA concentration was significantly (P = 0.01) lower in the haemodialysis patients than in those on peritoneal dialysis. In conclusion, this clinical study could not demonstrate significant benefits of AA in renal transplantation.

Efficacy and safety of perioperative vitamin C in patients undergoing noncardiac surgery: a systematic review and meta-analysis of randomised trials

“…Two other trials (n¼114) performed in kidney transplantation surgery did not report safety issues in patients receiving 225 and 500 mg of ascorbic acid. 37,50 A meta-analysis on acute rejection after kidney transplantation did not find a significant increase in rejection in the vitamin C group (14 of 59 [23.73%] vitamin C vs 12 of 74 [16.21%] control, RR¼1.41 [95% CI, 0.55 to 3.64], P¼0.48, I 2 ¼0%).…”

“…Furthermore, two other RCTs performed in the same setting reported no specific safety concerns in a cumulative population of 114 patients. 37,50 No trial performed in other transplant surgeries was retrieved. The same group of Borran and colleagues 61 lately published a narrative review on the use of vitamin C in kidney transplantation: no major safety issues were consistently reported in the literature, but vitamin C interactions with posttransplant drugs and five case reports of kidney transplant patients developing oxalate nephropathy after vitamin C (500 mge3 g day) were reported.…”

The Effect of Antioxidant Added to Preservation Solution on the Protection of Kidneys before Transplantation

“…Vitamin C showed a synergistic effect with prolactin. Norio et al [ 72 ] perfused kidneys with Euro-Collins solution and Euro-Collins solution with added vitamin C immediately before implantation into the recipient. The incidence of delayed graft function (DGF) was similar in both groups (32%/EC + vit.…”

Kidney transplantation from donors after cardiac death : studies on the pathophysiology and prevention of ischemic acute kidney injury and on the long-term outcome after transplantation

“…261,262 However, these findings were not reproduced in other clinical trials testing the effects on early graft function of superoxide dismutase, allopurinol or vitamin C administration. [263][264][265][266][267] It is important to note that markers of oxidative stress were not measured in most of these trials. Therefore, uncertainty remains regarding the effectiveness of the anti-oxidant interventions in reducing oxidative stress in the trial participants.…”