OPTIMIZING IMMEDIATE GRAFT FUNCTION IN KIDNEY TRANSPLANTATION

M.C. Warlé¹, K. Wever², L. Te riet², G.A. Rongen², J.A. Van der vliet^1
1Surgery, Division Of Vascular- And Transplant Surgery, University Medical Center St Radboud Nijmegen, Nijmegen/NETHERLANDS, ²Pharmacology And Toxicology, University Medical Center St Radboud Nijmegen, Nijmegen/NETHERLANDS

Body: Background: Remote ischemic preconditioning (RIPC) is a strategy to protect an organ against ischemia-reperfusion injury (IRI) by the application of briefischemia to an organ distant from the organ undergoing sustained ischemia. RIPC can be induced by transient occlusion of blood flow to a limb with a blood-pressure cuff and is a non-invasive,safe and low-cost procedure. Experimental data investigating the efficacy of RIPC to reduce kidney IRI are lacking. This study evaluated different protocols of RIPC using the hind limb as remoteorgan. Methods: To determine the optimal protocol of RIPC, hind limb ischemia was applied in Sprague Dawley rats using a 1.9cm cuff around one or both thighs, maintained for 0, 1×12 or 3×4 minutes at 200 mmHg; reperfusion was allowed for 0, 1×12 or 3×4 minutes respectively. Subsequently, left nephrectomy was performed and warm ischemia of the right kidney was induced by clamping of the renal pedicle for 25 minutes. Animals were housed for 48 hours in a metabolic cage, then they were sacrificed to determine renal function and kidney injury molecule-1 (KIM-1) mRNA expression. Results: Plasma creatinine levels were significantly reduced in the groups preconditioned with 3×4’ unilateral (200±34 µmol/l), 1×12’ bilateral (234±26 µmol/l) and 3×4’ bilateral (201±42 µmol/l) hind limb ischemia as compared to animals who were not preconditioned (333±38 µmol/l). A schedule of 1×12’ unilateral hind limb ischemia did not reduce plasma creatinine levels (322±46 µmol/l). In animals preconditioned with 1×12’ unilateral and 3×4’ bilateral hind limb ischemia, kidney KIM-1 expression was significantly reduced as compared to those who were not preconditioned. Conclusion: Our results show that RIPC using the hind limb as remote organ is a non-invasive and effective tool to reduce IRI of the kidney. In the setting of kidney transplantation, RIPC may improve early postoperative and long-term outcome.

Disclosure: All authors have declared no conflicts of interest.