Akbulut Gökhan, Serteser Mustafa, Polat Coşkun, Köken Tülay, Aktepe Fatma, Yilmaz Sezgin, Gokçe CiGdem, Gökçe Ozcan
Department of General Surgery, Afyon Kocatepe University, Afyon, Turkey.
Transplantation. 2002 Dec 27;74(12):1768-72. doi: 10.1097/01.TP.0000038730.30170.24.
Laparoscopic donor nephrectomy (LDN) is associated with prolonged warm ischemia, which could potentially increase oxidative stress in the graft. Because pneumoperitoneum (Pp) used to facilitate LDN impairs renal perfusion, it could augment the effects of warm ischemia. Our experimental, randomized, controlled study with blind outcome assessment is the first to address this possibility.
Wistar-Albino rats were randomized to 4 groups. Controls were subjected to a sham operation; the remainder were subjected to Pp with or without warm ischemia of differing durations. The kidneys were removed at the end of each experiment. The concentrations of malondialdehyde (MDA), protein carbonyl, and sulfhydryl groups and the activities of superoxide dismutase (SOD) and catalase were measured in renal samples as markers of oxidative stress. Renal samples were also evaluated histopathologically using light microscopy.
Pp promoted oxidative stress in renal tissues, with an increase of MDA and protein carbonyls and a decrease in protein sulfhydryls and SOD activity. Warm ischemia exerted an additive effect on Pp-associated oxidative stress only when sustained for 10 minutes. These changes occurred in the absence of light-microscopic evidence of overt tissue damage.
In an experimental model resembling LDN, Pp and 10 minutes of warm ischemia emerged as additive factors with respect to causing increased oxidative stress in the kidney. Because these effects imply subtle injury not only in the harvested kidneys of live donors but also in the kidneys the donors retain, avoiding Pp and warm ischemia above 5 minutes during LDN appears advisable.
腹腔镜供肾切除术（LDN）与较长时间的热缺血相关，这可能会增加移植肾中的氧化应激。由于用于辅助LDN的气腹（Pp）会损害肾脏灌注，因此可能会增强热缺血的影响。我们这项采用盲法评估结果的实验性随机对照研究首次探讨了这种可能性。
将Wistar - 白化大鼠随机分为4组。对照组进行假手术；其余组接受不同时长的有或无热缺血的气腹处理。在每个实验结束时取出肾脏。测定肾组织样本中丙二醛（MDA）、蛋白质羰基和巯基的浓度以及超氧化物歧化酶（SOD）和过氧化氢酶的活性，作为氧化应激的标志物。还使用光学显微镜对肾组织样本进行组织病理学评估。
Pp促进了肾组织中的氧化应激，表现为MDA和蛋白质羰基增加，蛋白质巯基和SOD活性降低。热缺血仅在持续10分钟时对与Pp相关的氧化应激产生累加效应。这些变化发生时，在光学显微镜下没有明显组织损伤的证据。
在类似LDN的实验模型中，Pp和10分钟的热缺血是导致肾脏氧化应激增加的累加因素。由于这些影响不仅意味着对活体供体切除的肾脏有细微损伤，对供体保留的肾脏也有损伤，因此在LDN期间避免Pp和超过5分钟的热缺血似乎是可取的。
