Sahraei Zahra, Salamzadeh Jamshid, Nafar Mohsen
Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Iran J Kidney Dis. 2015 Jan;9(1):56-62.
Delayed graft function (DGF) is a consequence of ischemia-reperfusion injuries in kidney allografts, for which no definite treatment is available. The neutrophil gelatinase-associated lipocalin (NGAL) and interleukin-18 (IL-18) are introduced as the most promising urine biomarkers to detect DGF. N-acetylcysteine (NAC) and vitamin C, well-known potent antioxidants that scavenge free radicals, may alleviate kidney injury. This study investigated the protective effects of NAC alone and in combination with vitamin C on DGF, by measuring IL-18 and NGAL in living donor kidney transplantations.
Patients transplanted between January 2011 and February 2013 were randomly divided into 3 groups to receive routine anti-rejection medication only (n = 32), NAC plus routine immunosuppressive regimen (NAC group; n = 33), and NAC and vitamin C plus routine regimen (NAC and vitamin C group; n = 19). Urine samples were taken 4 hours and 24 hours after transplantation. Enzyme-linked immunosorbent assay kits were utilized for measuring urine NGAL and IL-18.
There were no significant differences in the DGF prevalence and its duration between the study arms. Although the levels of NGAL and IL-18 decreased in the NAC and NAC and vitamin C groups, these reductions were not significant. Glomerular filtration rate at 30 and 60 days after transplantation were not significantly different between study groups, either.
Our results showed that NAC is a safe drug without significant adverse effects in kidney transplant recipients; however, its potential useful effects on urinary biomarkers of DGF were not illustrated in the present study.
移植肾延迟复功（DGF）是同种异体肾移植中缺血再灌注损伤的结果，目前尚无明确的治疗方法。中性粒细胞明胶酶相关脂质运载蛋白（NGAL）和白细胞介素-18（IL-18）被认为是检测DGF最有前景的尿液生物标志物。N-乙酰半胱氨酸（NAC）和维生素C是众所周知的强效抗氧化剂，可清除自由基，可能减轻肾脏损伤。本研究通过测量活体供肾移植中IL-18和NGAL，探讨了NAC单独及与维生素C联合应用对DGF的保护作用。
将2011年1月至2013年2月间接受移植的患者随机分为3组，分别仅接受常规抗排斥药物治疗（n = 32）、NAC加常规免疫抑制方案（NAC组；n = 33）以及NAC和维生素C加常规方案（NAC和维生素C组；n = 19）。移植后4小时和24小时采集尿液样本。使用酶联免疫吸附测定试剂盒测量尿液中的NGAL和IL-18。
各研究组之间DGF的发生率及其持续时间无显著差异。虽然NAC组和NAC与维生素C组中NGAL和IL-18的水平有所下降，但这些下降并不显著。各研究组移植后30天和60天的肾小球滤过率也无显著差异。
我们的结果表明，NAC对肾移植受者是一种安全的药物，无明显不良反应；然而，本研究未阐明其对DGF尿液生物标志物的潜在有益作用。
