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. |
