Keller Anna Krarup, Jorgensen Troels Munch, Ravlo Kristian, Nielsen Torben Kaer, Olsen L Henning, Stolle Lars B
Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
J Urol. 2009 Oct;182(4 Suppl):1854-9. doi: 10.1016/j.juro.2009.03.015. Epub 2009 Aug 19.
We designed an experimental renal transplantation model and evaluated microdialysis as a detector of induced postoperative ischemia, a feared complication that when caused by vascular thrombosis most often causes renal graft loss.
Two microdialysis catheters were placed in the left kidney in 16 pigs, including 1 superficially in the renal cortex and 1 fixed on the renal capsule. Two-hour baseline measurements were made at steady state, after which the kidney was removed and subjected to warm and cold ischemia. It was subsequently re-anastomosed end to end in situ and reperfused for 5 hours. Pigs were then randomized into a total renal artery occlusion and a control group.
At baseline there were no changes in local metabolites (glucose, glutamate, glycerol and lactate) and no significant difference between the groups. Glycerol increased 4-fold in each group during cold ischemia but there were no pivotal alterations in other metabolites. After kidney reperfusion glycerol decreased and all metabolites were in steady state after 1 hour. At 30 minutes after postoperative ischemia was introduced there were significant increases in all kidneys in ischemia vs steady state reperfusion levels of cortical lactate, glutamate, glycerol and the lactate-to-glucose ratio (each rank sum test p <0.001). No metabolic changes were seen in controls.
Microdialysis detected significant metabolic changes after postoperative ischemia in pigs with experimental renal transplantation, while no metabolic changes were observed in controls. In the future microdialysis may become a valuable tool for postoperative observation of transplanted kidneys, most probably with major impact on early graft survival.
我们设计了一种实验性肾移植模型，并评估微透析作为术后诱导性缺血检测手段的效果。术后缺血是一种令人担忧的并发症，当由血管血栓形成引起时，最常导致肾移植失败。
在16头猪的左肾中放置两根微透析导管，其中一根浅置于肾皮质，另一根固定在肾包膜上。在稳态下进行两小时的基线测量，之后切除肾脏并使其经历热缺血和冷缺血。随后将其原位端端重新吻合并再灌注5小时。然后将猪随机分为完全肾动脉闭塞组和对照组。
基线时，局部代谢物（葡萄糖、谷氨酸、甘油和乳酸）无变化，两组之间无显著差异。在冷缺血期间，每组甘油增加了4倍，但其他代谢物无关键变化。肾脏再灌注后甘油下降，1小时后所有代谢物均处于稳态。在引入术后缺血30分钟时，与稳态再灌注水平相比，所有缺血肾脏的皮质乳酸、谷氨酸、甘油以及乳酸与葡萄糖比值均显著增加（各秩和检验p<0.001）。对照组未见代谢变化。
微透析检测到实验性肾移植猪术后缺血后有显著的代谢变化，而对照组未观察到代谢变化。未来，微透析可能成为观察移植肾术后情况的一种有价值的工具，很可能对早期移植物存活有重大影响。
