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Hypothermic Preservation of Transplanted Kidneys
Kidney replacement therapy is a general term used to describe medical procedures that help to treat end-stage renal disease (ESRD). It is possible to obtain this goal, with certain limitations, by dialysis; however, the only method for obtaining a healthy organ is kidney transplantation (KTx). A growing number of patients on the transplant waiting lists and an insufficient donor pool remain a significant concern in all countries. There are strategies focused on increasing the number of donations, including the promotion of living donations. Despite donation after brainstem death (DBD), which is the primary source of organs for transplantation, there are an increasing number of extended criteria donor (ECD) and donation after circulatory death (DCD) cases. Improvement of transplantation procedures allowed to overcome past restrictions and possible contraindications. KTx outcomes are improving, and there are many factors involved, including gender.
Ischemia-reperfusion injury (IRI) after renal transplantation is a complex biochemical process. The first component is an ischemic phase during kidney storage. The second is reperfusion, the main source of oxidative stress. This study aimed to analyze the activity of enzymes and concentrations of non-enzymatic compounds involved in the antioxidant defense mechanisms: glutathione (GSH), glutathione peroxidase (GPX), catalase (CAT), superoxide dismutase (SOD), glutathione reductase (GR), glutathione transferase (GST), thiobarbituric acid reactive substances (TBARS), malondialdehyde (MDA), measured in preservation fluid before transplantation of human kidneys (KTx) grafted from brain dead donors. The study group (N = 66) was divided according to the method of kidney storage: Group 1—hypothermic machine perfusion (HMP) in LifePort perfusion pump, n1 = 26, and Group 2—static cold storage (SCS), n2 = 40. The measurements of kidney function parameters, blood count, and adverse events were performed at constant time points during 7-day hospitalization and 3-month follow-up. Kidney perfusate in Group 2 was characterized by significantly more acidic pH (p < 0.0001), higher activity of GPX [U/mgHb] (p < 0.05) and higher concentration of MDA [μmol/L] (p < 0.05). There was a statistically significant improvement of kidney function and specific blood count alterations concerning storage method in repeated measures. There were aggregations of significant correlations (p < 0.05) between kidney function parameters after KTx and oxidative stress markers: diuresis & CAT, Na+ & CAT, K+ & GPX, urea & GR. There were aggregations of significant correlations (p < 0.05) between recipient blood count and oxidative stress markers: CAT & MON, SOD & WBC, SOD & MON. Study groups demonstrated differences concerning the method of kidney storage. A significant role of recipient’s gender, gender matching, preservation solution, and perfusate pH was not confirmed, however, basing on analyzed data, the well-established long-term beneficial impact of HMP on the outcome of transplanted kidneys might partially depend on the intensity of IRI ischemic phase and oxidative stress, reflected by the examined biomarkers.
2. Kidney Replacement Therapy
The entry is from 10.3390/antiox10081263
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