Navratil Pavel, Chalupnik Jiri, Rehak David, Gorskaja Diana, Ticha Alena, Weishaupt David, Cizkova Dana, Cermakova Eva, Bezrouk Ales, Astapenko David
>From the Department of Urology, University Hospital Hradec Kralove, Hradec Kralove, Czechia; and the Charles University, Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czechia.
Exp Clin Transplant. 2025 Aug;23(8):509-516. doi: 10.6002/ect.2024.0222.
Kidney transplant is a life-saving procedure for patients with end-stage renal disease. Success of kidney transplant is highly dependent on maintaining the integrity of the endothelium and its protective layer, the endothelial glycocalyx. Ischemia-reperfusion injury, a common challenge in kidney transplant, can disrupt the endothelial glycocalyx, leading to various post-transplant complications. We investigated the effects of albumin and sulodexide, 2 therapeutic agents, for protection of the endothelium and endothelial glycocalyx in a porcine model of kidney transplant.
Fourteen female piglets were prepared for kidney transplant simulation and randomly divided into 3 groups: a control group, an albumin-treated group, and a sulodexide-treated group. Various physiological parameters were monitored, and samples for serum and urine were collected at baseline and at multiple time points after reperfusion. Integrity of the endothelial glycocalyx was assessed from serum syndecan-1 levels and urinary glycosaminoglycan concentrations. Histology of the renal cortex allowed evaluation of tissue changes following the intervention.
Statistically significant differences were observed in the sulodexide-treated group, where serum syndecan-1 levels were lower versus the control group at 5 minutes after reperfusion (P = .046), indicating a potential reduction in endothelial glycocalyx damage. Similarly, in the albumin-treated group, urinary glycosaminoglycan levels were significantly lower versus the control group at 5 minutes after reperfusion (P = .041), which may suggest a protective effect on the endothelial glycocalyx. However, these findings are preliminary, and no other significant differences were detected between the treatment groups and the control group at later time points. Histology of the renal cortex revealed that the changes were generally minor across all groups.
We suggest that albumin and sulodexide may offer beneficial effects in preserving endothelial function during kidney transplant. The potential for these agents to enhance graft survival and improve kidney transplant outcomes warrants further investigation.
肾移植是终末期肾病患者的一种挽救生命的手术。肾移植的成功高度依赖于维持内皮及其保护层（内皮糖萼）的完整性。缺血再灌注损伤是肾移植中常见的挑战，可破坏内皮糖萼，导致各种移植后并发症。我们在猪肾移植模型中研究了两种治疗药物白蛋白和舒洛地昔对内皮及内皮糖萼的保护作用。
准备14只雌性仔猪用于肾移植模拟，并随机分为3组：对照组、白蛋白治疗组和舒洛地昔治疗组。监测各种生理参数，并在基线和再灌注后的多个时间点采集血清和尿液样本。根据血清syndecan-1水平和尿糖胺聚糖浓度评估内皮糖萼的完整性。通过肾皮质组织学评估干预后的组织变化。
在舒洛地昔治疗组观察到统计学上的显著差异，再灌注后5分钟时血清syndecan-1水平低于对照组（P = 0.046），表明内皮糖萼损伤可能有所减轻。同样，在白蛋白治疗组中，再灌注后5分钟时尿糖胺聚糖水平显著低于对照组（P = 0.041），这可能表明对内皮糖萼有保护作用。然而，这些发现是初步的，在后续时间点治疗组与对照组之间未检测到其他显著差异。肾皮质组织学显示所有组的变化通常较小。
我们认为白蛋白和舒洛地昔在肾移植期间保护内皮功能方面可能具有有益作用。这些药物提高移植物存活率和改善肾移植结果的潜力值得进一步研究。
