Reperfusion injury in renal transplantation revascularization
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Ischaemia-reperfusion injury plays an important role in acute tubular necrosis (ATN) which commonly complicates cadaveric renal transplantation. Free radicals liberated from accumulated hypoxanthine on reperfusion are responsible for most of the injury. This work aims to study the order of initial reperfusion (venous versus arterial) on early graft function following transplantation. Between July and September 1995 29 patients with chronic renal failure on dialysis undergoing cadaveric renal transplantation were randomised in this clinical trial. In 16 patients standard initial arterial reperfusion was performed , while 13 had initial venous reperfusion. Previous studies have shown that erythrocytes can act as scavengers of hypoxanthine under conditions of low pH, low P02, and high inorganic phosphate levels. These conditions occur in venous blood return from the ischaemic ipsilateral lower limb after temporary clamping of external iliac vessels during surgery. Patients with renal allografts perfused initially with venous blood had lower serum creatinine levels and higher creatinine clearance compared to patients with grafts perfused with arterial blood. ATN complicated 2 patients (15.4%)in the arterial reperfusion group and 2 patients (12.5%) in the venous revascularisation group. Perfusion of allografts with venous blood first may help to decrease reperfusion injury.