NDT Advance Access originally published online on May 5, 2004
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Nephrol Dial Transplant (2004) 19: 1742-1751
Nephrol Dial Transplant Vol. 19 No. 7 © ERA-EDTA 2004; all rights reserved
Original Article
Evidence for protective roles of polyethylene glycol plus high sodium solution and trimetazidine against consequences of renal medulla ischaemia during cold preservation and reperfusion in a pig kidney model
1 INSERM ERM Poitiers, Unité de Transplantation Expérimentale, Département de Génétique Animale, Institut National de Recherche Agronomique, Domaine du Magneraud, BP 52, 17700 Surgères, and Centre Hospitalier et Universitaire, Hôpital Jean Bernard, Poitiers, 2 Laboratoire de Pharmacologie and Centre National de la Recherche Scientifique, Faculté de Médecine de Paris XII, F-94010 Créteil and 3 INSERM U 478, IFR 02, Faculté de Médecine Xavier Bichat, Paris, France
Correspondence and offprint requests to: Dr Thierry Hauet, INSERM ERM 324, BP 570, Rue de La Milétrie, CHU de Poitiers, 86000 Poitiers, France. Email: t.hauet{at}chu-poitiers.fr
Background. The renal medulla is particularly sensitive to oxidant stress and to ischaemia–reperfusion injury (IRI). In organ transplantation, delayed graft function is an important problem and cold ischaemia is thought to be the most important factor in short- and long-term complications. Our aim was to study cold-induced damage in proximal tubular segments and renal medulla osmolite excretion during use of various preservation solutions, and to clarify the role of trimetazidine (TMZ) in limiting renal dysfunction.
Methods. Using an autotransplanted pig kidney model, we assessed renal tubule function, medullary osmolite excretion and renal damage between day 1 and week 2 after 24 or 48 h cold storage in University of Wisconsin solution (UW), Celsior and ECPEG (two new high Na+ preservation solutions) or the Hopital Edouard Herriot solution (HEH; a high Na+ version of UW). In additional groups, TMZ was added to these preservation solutions for 24 and 48 h cold storage.
Results. Renal function was reduced under these preservation conditions. Tubular injury was associated with aminoaciduria and with a limited Na+ reabsorbtion. Medullary damage led to the early appearance of trimethylamine-N-oxide and dimethylamine in urine. However, renal damage was modulated by preservation conditions. In addition, TMZ added to each of the solutions efficiently protected against IRI even after prolonged preservation.
Conclusion. TMZ efficiently protected kidneys against damage when added to the HEH and particularly ECPEG solutions, even after 24 h cold storage. These findings point to a role for drugs that target mitochondria, and demonstrate that TMZ may provide a valuable therapeutic tool against IRI and could be included in therapeutic protocols.
Keywords: cold preservation; ischaemia–reperfusion injury; pig kidney model; trimetazidine