Progressive Development of Renal Vascular Dysfunction in Brain Death Implicates Reversible Alterations of Nitric Oxide Metabolism

• Published in: Transplantation proceedings Vol. 43; no. 5; pp. 1495 - 1502
• Main Authors: Andrási, T.B, Stumpf, N, Blázovics, A
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Inc 01.06.2011; Elsevier
• Subjects: Animals; Biological and medical sciences; Blood Vessels; Brain Death; Disease Progression; Dogs; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Hemodynamics; Kidney - blood supply; Medical sciences; Nitric Oxide - metabolism; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tissue, organ and graft immunology; Brain death; Alteration; Cardiovascular disease; Transplantation; Metabolism; Kidney; Medicine; Vascular disease; Progressive; Treatment; Urinary system; Surgery; Nitric oxide; Development; Graft; Pharmacokinetics
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2011.02.018

Abstract Background Vascular endothelial dysfunction occurs in the kidney graft from marginal brain death (BD) donors and may be responsible for a low success rate after transplantation. Methods BD was induced in 16 dogs for 6 hours. Immediately after the inflation of the intracranial balloon, the treated group (n = 8) received 40 mg/kg bolus followed by 3 mg/kg/min infusion of L-arginine for 30 minutes. Renal vascular function and hemodynamic and biochemical parameters were determined. Results BD caused vasoconstriction, increase in renal venous nitrite (4.9 ± 0.8 versus 2.6 ± 0.1, P < .05) and myeloperoxidase levels (1.43 ± 0.04 versus 2.43 ± 0.23, P < .001), and reduced vasodilatation of renal artery to acetylcholine. Larginine diminished the renal vasoconstriction induced by 6 hour BD (RVR = 0.92 ± 0.06 versus 1.38 ± 0.003 in controls, P < .05), maintained renal oxygen extraction in physiological range (17.5 ± 4.6% versus 25.4 ± 2.9% in controls, P < .05) and prevented the rise of myeloperoxidase (1.69 ± 0.19, P < .05 versus controls) and nitrite levels (3.3 ± 0.5, P < .05), followed by preservation of endothelium dependent vasodilatation ( P < .05 versus controls). Conclusions The findings suggest that exogenous L-arginine supplementation may preserve endothelial vascular function in the kidney before prelevation from marginal BD donors.