Human Renal Allograft Blood Flow and Early Renal Function

Anderson, Charles B.; Etheredge, Edward E.

doi:10.1097/00000658-197711000-00003

Cited by 26 publications

(15 citation statements)

References 5 publications

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“…Despite the profound reduction in glomerular filtration rate, total renovascular resistance of DCD kidneys was similar to that of living donor kidneys in the early reperfusion period. This finding seems to contradict previous publications that have shown a correlation between volumetric renal blood flow and early graft function (1,2,22). However, such studies are scarce and typically did not adjust for perfusion pressure and kidney weight, which may result in a confounded impression of renal hemodynamics.…”

Section: Discussioncontrasting

confidence: 56%

Acute ischemic injury to the renal microvasculature in human kidney transplantation

Snoeijs¹,

Vink²,

Voesten³

et al. 2010

American Journal of Physiology-Renal Physiology

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Increased understanding of the pathophysiology of ischemic acute kidney injury in renal transplantation may lead to novel therapies that improve early graft function. Therefore, we studied the renal microcirculation in ischemically injured kidneys from donors after cardiac death (DCD) and in living donor kidneys with minimal ischemia. During transplant surgery, peritubular capillaries were visualized by sidestream darkfield imaging. Despite a profound reduction in creatinine clearance, total renovascular resistance of DCD kidneys was similar to that of living donor kidneys. In contrast, renal microvascular perfusion in the early reperfusion period was 42% lower in DCD kidneys compared with living donor kidneys, which was accounted for by smaller blood vessel diameters in DCD kidneys. Furthermore, DCD kidneys were characterized by smaller red blood cell exclusion zones in peritubular capillaries and by greater production of syndecan-1 and heparan sulfate (main constituents of the endothelial glycocalyx) compared with living donor kidneys, providing strong evidence for glycocalyx degradation in these kidneys. We conclude that renal ischemia and reperfusion is associated with reduced capillary blood flow and loss of glycocalyx integrity. These findings form the basis for development of novel interventions to prevent ischemic acute kidney injury. ischemia-reperfusion injury; endothelial glycocalyx KIDNEY TRANSPLANTATION IS inevitably associated with ischemia and reperfusion injury. Depending on the severity of injury, 20 -80% of recipients of deceased donor kidneys require dialysis treatment in the first week after transplantation, which is referred to as delayed graft function (26). This condition complicates patient management and is associated with a 40% increased rate of graft loss in kidneys from donors after brain death (45). Liberal use of donations after cardiac death greatly expands the number of available donor kidneys and may even eliminate transplant waiting lists (37). However, kidneys from these donors suffer extensive ischemic injury from circulatory arrest until organ preservation, which almost invariably leads to delayed graft function after transplantation. More importantly, up to 15-25% of these kidneys will never regain function, unnecessarily exposing recipients to the risks of major surgery and immunological sensitization (43).Adequate reperfusion is essential for functional recovery of donor kidneys and prevents ongoing ischemic tissue injury after revascularization. In rodent models of ischemic acute kidney injury, it has been demonstrated that the peritubular microcirculation suffers endothelial injury and functional impairment after reperfusion (5, 44), which has recently been observed in humans as well (13,21,31). The endothelium is covered by the glycocalyx, a dynamic network of proteoglycans and glycoproteins that determines vascular permeability, transduces shear stress to the endothelium, and prevents interaction of leukocytes and platelets with the vascular wall (29). Loss of endothel...

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Section: Discussioncontrasting

confidence: 56%

Acute ischemic injury to the renal microvasculature in human kidney transplantation

Snoeijs¹,

Vink²,

Voesten³

et al. 2010

American Journal of Physiology-Renal Physiology

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“…This technique has been used to measure RBF in critically ill patients [14] . Direct flow meters have been used intraoperatively to assess RBF in native [31] and transplant kidneys [12,13] . More recently, cine phase contrast MRI has been used to measure RBF noninvasively and without exogenous contrast [57,58] .…”

Section: Techniques For the Measurement Of Rbfmentioning

confidence: 99%

Renal Blood Flow during Acute Renal Failure in Man

et al. 2009

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Background:In the critically ill, ischemia secondary to decreased renal blood flow (RBF) is believed to be central to the pathogenesis of acute renal failure (ARF); however, the scientific basis for this conclusion has not been systematically evaluated. Methods: Systematic interrogation of the Pubmed database, and screening bibliographies of retrieved reports, for studies of human ARF where RBF was measured. Results: Thirty-two articles published between 1944 and 2008 describing RBF in 373 patients with ARF were identified. Overall, mean RBF during ARF was 387 ml/min. It was 329 ml/min when estimated by clearance-based techniques (15 studies) and 471 ml/min when measured with nonclearance-based techniques (17 studies). Only 46 patients had measurements in the intensive care unit where mean RBF was 306 ml/min. Normal RBF was reported in 14 publications, mean 1,192 ml/min. Conclusions: Limited information is available on RBF during ARF in the critically ill. Measurements in contemporary patients are required to further our understanding of this condition.

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“…In previous investigations in our laboratory and by other authors it was found that high blood flow rates immediately after restoration o f blood flow in the renal artery, measured electromagnetically, indicated a better initial graft function (2,25). These findings together with our results show that the hemodynamic condition during the preservation and immediately after trans plantation might play an important role in the later prognosis o f transplanted kidneys.…”

Section: Discussionmentioning

confidence: 78%

Clinical Experiences in the Gambro-Preservation Unit: Analysis of 101 Human Cadaver Kidneys

Horpácsy¹,

Scholz²,

Althaus³

et al. 1979

Eur Surg Res

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101 human cadaver kidneys were preserved by means of hypofhermic pulsatile perfusion in the Gambro perfusion unit with human albumin as perfusate. Perfusate flow and some biochemical parameters were assessed during perfusion and correlated with renal function after transplantation. There is a good correlation between perfusate flow and recovery of physiological renal function. LDH released to the perfusate as viability test is of limited value: a direct correlation was only found between LDH activity and perfusion time, and LDH activity and ischemia time. Determination of pH and lactic acid level 1 h after beginning of perfusion is without practical value according to our experience. The quality of albumin in perfusion solution influences the immediate graft function.

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Human Renal Allograft Blood Flow and Early Renal Function

Cited by 26 publications

References 5 publications

Acute ischemic injury to the renal microvasculature in human kidney transplantation

Acute ischemic injury to the renal microvasculature in human kidney transplantation

Renal Blood Flow during Acute Renal Failure in Man

Clinical Experiences in the Gambro-Preservation Unit: Analysis of 101 Human Cadaver Kidneys

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