1. Kidney graft outcome using an anti-Xa therapeutic strategy in an experimental model of severe ischaemia–reperfusion injury
- Author
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B Renelier, R. Thuillier, Gérard Mauco, Jean-Michel Goujon, Solenne Tillet, Sébastien Giraud, Pierre-Olivier Delpech, Thierry Hauet, Laurent Macchi, Virginie Ameteau, Ischémie Reperfusion en Transplantation d’Organes Mécanismes et Innovations Thérapeutiques ( IRTOMIT), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Poitiers - Faculté de Médecine et de Pharmacie, Université de Poitiers, Centre hospitalier universitaire de Poitiers (CHU Poitiers), Service de Néphrologie CHU Poitiers, Génétique, Expérimentation et Système Innovants (GenESI), Institut National de la Recherche Agronomique (INRA), Institut National de la Santé et de la Recherche Médicale, Conseil Régional Poitou-Charentes, Centre Hospitalier Universitaire de Poitiers, and INRA
- Subjects
medicine.medical_specialty ,Adenosine ,Swine ,[SDV]Life Sciences [q-bio] ,Allopurinol ,Organ Preservation Solutions ,Ischemia ,Urology ,Cold storage ,Renal function ,030204 cardiovascular system & hematology ,Kidney ,Fondaparinux ,Transplantation, Autologous ,03 medical and health sciences ,Raffinose ,0302 clinical medicine ,Polysaccharides ,Leukocytes ,medicine ,Animals ,Insulin ,Viaspan ,Warm Ischemia ,030304 developmental biology ,0303 health sciences ,Nephritis ,business.industry ,Anticoagulants ,medicine.disease ,Constriction ,Glutathione ,Kidney Transplantation ,3. Good health ,Surgery ,Transplantation ,medicine.anatomical_structure ,Reperfusion Injury ,Cytokines ,business ,Reperfusion injury ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology ,medicine.drug - Abstract
BackgroundDeceased after cardiac death donors represent an important source of organs to reduce organ shortage in transplantation. However, these organs are subjected to more ischaemia–reperfusion injury (IRI). Reducing IRI by targeting coagulation is studied here in an experimental model.MethodsThe effect of an anti-Xa compound (fondaparinux) was evaluated using an autotransplanted kidney model in pigs. Kidneys were clamped for 60 min (warm ischaemia) and then preserved for 24 h at 4°C in University of Wisconsin solution (UW). The anti-Xa compound was injected intravenously before warm ischaemia and used during cold storage, and its effects were compared with those of intravenous injection of unfractionated heparin (UFH) before warm ischaemia and use during cold storage, or use of UW alone during cold storage.ResultsAt 3 months after transplantation, anti-Xa treatment improved recovery of renal function and chronic serum creatinine levels compared with UW and UFH (mean(s.e.m.) 89(4), 250(4) and 217(8) µmol/l respectively). The anti-Xa treatment also reduced fibrosis, and decreased tissue expression of markers of the epithelial–mesenchymal transition compared with UW and UFH. Cleaved protease-activated receptor 2 was overexpressed in the UW group compared with the anti-Xa and UFH groups. Leucocyte infiltrates were decreased in the anti-Xa group compared with the UW and UFH groups. Macrophage invasion was also decreased by anticoagulation treatment.ConclusionPeritransplant anticoagulation therapy was beneficial to graft outcome, in both the acute and chronic phases. Moreover, specific inhibition of coagulation Xa protease further protected kidney grafts, with better recovery and decreased expression of chronic lesion markers. Surgical relevanceThe increasing use of marginal donors highlights the importance of organ quality in transplantation. Renal ischaemia–reperfusion injury (IRI), which includes a deleterious activation of coagulation, plays a central role in determining graft quality and outcome.Using an established porcine renal autotransplantation preclinical model with high clinical relevance, the benefits of anticoagulation therapy using an antifactor Xa molecule were evaluated. Peritransplantion anticoagulation treatment, specifically with an anti-Xa compound, protected marginal kidney grafts, improving functional recovery and reducing chronic lesions.This study demonstrates the benefits of anticoagulation therapy at the time of organ collection, particularly for marginal organs, encountered in cases of extended criteria and deceased after circulatory death donors. This anticoagulation strategy could be an important addition to current donor and organ management protocols in order to limit IRI and improve outcome.
- Published
- 2014