Burns A T, Davies D R, McLaren A J, Cerundolo L, Morris P J, Fuggle S V
Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, Headington, United Kingdom.
Transplantation. 1998 Oct 15;66(7):872-6. doi: 10.1097/00007890-199810150-00010.
Ischemia/reperfusion injury of human renal allografts has a number of clinically significant consequences. A number of mechanisms of ischemia/ reperfusion injury have been elucidated, and there is evidence that apoptosis may be a contributing factor.
To examine immediate posttransplant events, fixed tissue sections from paraffin-embedded wedge biopsy specimens taken before and after reperfusion of human renal allografts were stained using terminal deoxytransferase-mediated dUTP nick-end labeling to detect the DNA fragmentation characteristic of apoptosis. Thirty-six pairs of pre- and postreperfusion biopsy specimens were examined, 11 from living-related donor renal transplants and 25 from cadaveric donor transplants.
Quantitation of the terminal deoxytransferase-mediated dUTP nick-end labeling signal showed that significantly more apoptosis occurred in postreperfusion compared with prereperfusion biopsy specimens from cadaveric donor transplants, but a similar difference was not observed in living-related donor renal transplants. Furthermore, significantly more apoptosis was observed in postreperfusion biopsy specimens from cadaveric compared with living-related renal transplants. Postreperfusion biopsy specimens from kidneys that were cold preserved longer than 30 hr had a higher mean apoptosis score than those stored for less than 24 hr, but the result was not statistically significant.
Thus, apoptosis occurs predominantly as a result of reperfusion after cold preservation of cadaveric donor renal allografts and provides additional information regarding the extent of ischemia/ reperfusion injury in an organ. The clinical value of this information remains to be determined.
人类肾移植的缺血/再灌注损伤会产生许多具有临床意义的后果。缺血/再灌注损伤的多种机制已得到阐明，并且有证据表明细胞凋亡可能是一个促成因素。
为了研究移植后即刻发生的事件，对人肾移植再灌注前后获取的石蜡包埋楔形活检标本的固定组织切片，采用末端脱氧核苷酸转移酶介导的dUTP缺口末端标记法染色，以检测细胞凋亡特有的DNA片段化。检查了36对再灌注前后的活检标本，其中11例来自亲属活体供肾移植，25例来自尸体供肾移植。
末端脱氧核苷酸转移酶介导的dUTP缺口末端标记信号定量显示，与尸体供肾移植再灌注前的活检标本相比，再灌注后发生的细胞凋亡明显更多，但亲属活体供肾移植中未观察到类似差异。此外，与亲属活体肾移植相比，尸体供肾移植再灌注后的活检标本中观察到的细胞凋亡明显更多。冷保存时间超过30小时的肾脏再灌注后的活检标本平均凋亡评分高于保存时间少于24小时的标本，但结果无统计学意义。
因此，细胞凋亡主要是尸体供肾移植冷保存后再灌注的结果，并提供了有关器官缺血/再灌注损伤程度的额外信息。该信息的临床价值仍有待确定。
