| Background and Objective: During the renal transplantation, because of hot ischemia-, warm ischermia,cool ischemia and reobstaining renal circulation, ischemia/reperfusion (IR) will inevitably results in a serious injury to the donor kidney. Although the pathophysiologic mechanisms of the kidney IR injury are not completely understood, the more and more studies have shown that cytokines may play an important role in IR. Ulinastatin (UTI) is a kind of broad-spectrumed proteases inhibitor, taken from healthy adult urine, which can decrease pro-inflammatory cytokines release and promote anti-inflammatory cytokines release in many patho physio logic process. The effects of UTI on pro-inflammatory cytokines(TNF-a^IL-6>IL-8) and anti-inflammatory cytokine (IL-10), early stage's urinal flow of grafted kidney and the plasma concentration of Creatinine were studied during renal transplantation. The possible other benefit from UTI application during renal transplatation also was observed.Methods: Forty ASA II -III patients received elective renal transplantation were randomly divided into two groups: control group(C group, n=20), ulinastatin was not be used in the patients and ulinastatinIVgroup (U group, n=20), UTI of 10000 unite per kilogram was given to each patient. All the patients were received continuous epidual anesthesia. Blood samples were taken from the central vein before anesthesia(Ti): at the time of starting operation (T2), at the time of releasing the renal artery(T3), at the time when operation was finished (T4), on the first day after operation(T5), on the third day after operation(T6) for determination of plasma concentration of TNF-a, IL-6, IL-8 and IL-10. The renal urinal flow and the plasma concentration of Creatinine from the first day to the third day after operation were observed too.Results: (1) The plasma concentration of TNF-a ^ IL-6> IL-8 significantly increased from the time of releasing the artery to the third day after operation (P<0.01), and it violently increased at T3, and peaked at T4, as compared with before anesthesia in two groups (P<0.01), but increasing amplitude in groupU was smaller than that in group C; at T3, T4, T5, T6, there were significant difference between the two groups(P<0.01).(2) The plasma level of IL-10 at T3, T4, T5 T6 was all higher than that at TI and T2 (p<0.01) in two groups, and they all peaked at T4, then, they all fell again. They were higher than the baseline (P<0.05),but there was no significant difference between Group C and Group U(P>0.05). (3) The group in contrast with the group C, the urine flow in group U was more than that in group C from the first day to the third day after operation (P<0.05). (4) The group U in contrast with thevgroup C, the plasma level of Cr had no significant difference on the first day after operation (P>0.05), but the plasma level of Cr in group U was lower than that in group C from the second day to the third day (P<0.05). (5) After operation, one case had acute tubular necrosis (ATN), one case had lung inflammation, one case had liver inflammation in group C, but no case has those things in group U.Conclusions: (1) The plasma concentration of TNF-α, IL-6, IL-8, and IL-10 increased significantly during renal transplatation,which may be related to renal ischemia-reperfusion injury.(2)Ulinastatin reduced the concentration of the some cytokines, which may have protective effects on renal ischemia-reperfusion during renal transpatation. (3) Ulinastatin may early accelerate renal function recovery in patients with renal transpalation. |
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