Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
Langenbecks Arch Surg. 2013 Jan;398(1):87-97. doi: 10.1007/s00423-012-1010-0. Epub 2012 Oct 16.
During kidney transplantation (KTx), the length of cold ischemia time (CIT) and the subsequent changes in energy metabolism may lead to variations in interstitial metabolites. Using microdialysis (MD), we evaluated the effects of a short and long CIT on changes of these metabolites.
Sixteen pigs were randomized in two identical groups, one with a short CIT and the other one with a long CIT. Using MD in the transplanted grafts, we evaluated the parenchyma concentrations of glucose, lactate, pyruvate, glutamate and glycerol in different stages.
We noted that during the warm ischemia time (WIT) and in the early post-reperfusion phase glucose levels increased more significantly in the long CIT group and remained high until the end of monitoring. At the end of CIT and during WIT, the long CIT group had a significantly higher glycerol level, but the level dropped gradually in the late post-reperfusion phase and reached a steady state in both groups.
The extended CIT clearly results in considerably impaired graft metabolism. The high interstitial glucose levels within hours after KTx could be considered as a marker of primary delayed function of the graft. Furthermore, the glycerol value could reflect the extent of graft injury during the ischemia time or in case of acute impairment of graft perfusion.
在肾移植（KTx）过程中，冷缺血时间（CIT）的长短以及随后能量代谢的变化可能导致间质代谢物的变化。我们使用微透析（MD）来评估短CIT 和长 CIT 对这些代谢物变化的影响。
将 16 头猪随机分为两组，每组各有 8 头，一组 CIT 较短，另一组 CIT 较长。使用 MD 评估移植移植物不同阶段的间质葡萄糖、乳酸、丙酮酸、谷氨酸和甘油的浓度。
我们注意到，在 WIT 和早期再灌注阶段，长 CIT 组的葡萄糖水平增加更为显著，并且在监测结束前一直保持较高水平。在 CIT 结束和 WIT 期间，长 CIT 组的甘油水平显著升高，但在再灌注晚期逐渐下降，两组均达到稳定状态。
延长 CIT 明显导致移植物代谢受损。KTx 后数小时内间质中高葡萄糖水平可被视为移植物原发性延迟功能的标志物。此外，甘油值可以反映缺血时间或移植物灌注急性受损期间的移植物损伤程度。
