| Association of graft neutrophil sequestration with delayed graft function in clinical renal transplantation. | |
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MedLine Citation:
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PMID: 15223898 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The authors studied the impact of neutrophil activation, detected in experimental models, on reperfusion injury in clinical renal transplantation. METHODS: Forty-five patients from a larger trial comparing three immunosuppressive protocols were recruited: perioperative antithymocyte globulin (ATG) with low initial cyclosporine A (CsA) triple therapy (group A, n=15); two-dose basiliximab with low initial CsA triple therapy (group B, n=16); and conventional triple therapy (group C, n=14). Blood samples were obtained preoperatively, before reperfusion, and at 1 and 5 min after reperfusion. During reperfusion, samples were collected from the iliac artery and the graft vein for calculation of transrenal differences (Delta) of study parameters. Leukocyte differential counts, plasma lactoferrin concentration, and neutrophil CD11b and L-selectin expressions were assessed. Graft blood flow was measured at 2 and 30 min after reperfusion. RESULTS: ATG induced neutrophil activation already before reperfusion. Thus, group A was excluded, but groups B and C were pooled for analysis of reperfusion-induced neutrophil activation. At 1 min after reperfusion, lactoferrin concentration was higher in graft vein than iliac artery, yielding Delta=15 microg/L (P<0.05). Concomitantly, Delta neutrophil count correlated with both Delta L-selectin expression (R=0.49, P=0.012) and graft blood flow at 2 min (R=0.51, P=0.007). At 5 min after reperfusion, 0.17 (-1.0-0.24)x10 cells/L neutrophils were sequestered in the graft (P<0.001). This sequestration correlated with graft blood flow at 30 min (R=0.53, P=0.005) and was stronger in patients with delayed graft function (DGF) (Delta = -0.38 [-1.45 to -0.2]) than those without (Delta = -0.12 [-0.41-0.24], P<0.001). In multiple regression analysis, sequestration was the most important parameter associated with DGF. CONCLUSIONS: Neutrophils are activated and sequestered in the reperfused graft during clinical renal transplantation. Neutrophil sequestration is a powerful independent factor explaining the incidence of DGF. |
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Authors:
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Arto J Turunen; Leena Lindgren; Kaija T Salmela; Lauri E Kyllönen; Heikki Mäkisalo; Sanna M Siitonen; Eero J Pesonen |
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Publication Detail:
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Type: Clinical Trial; Comparative Study; Controlled Clinical Trial; Journal Article; Meta-Analysis |
Journal Detail:
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Title: Transplantation Volume: 77 ISSN: 0041-1337 ISO Abbreviation: Transplantation Publication Date: 2004 Jun |
Date Detail:
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Created Date: 2004-06-29 Completed Date: 2004-08-10 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0132144 Medline TA: Transplantation Country: United States |
Other Details:
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Languages: eng Pagination: 1821-6 Citation Subset: IM |
Affiliation:
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Department of Anaesthesiology and Intensive Care Medicine, Helsinki University Hospital, Haartmanninkatu 4, 00029 HUS Helsinki, Finland. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Drug Therapy, Combination Humans Immunosuppressive Agents / therapeutic use* Kidney Transplantation / physiology* Leukocyte Count Middle Aged Neutrophils / physiology* Reperfusion Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Immunosuppressive Agents |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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