| Ischemia-reperfusion injury(IRI)refers to damage to tissues or organs caused when blood or oxygen supply returns to the tissues or organs after a period of ischemia, involving the formation of oxygen-derived free radicals,neutrophil infiltration multiple pathophysiological changes,mechanism is very complex:cell membrane damage,increase of intracellular calcium,high-energy phosphate depletion,loss of mitochondrial reactive,osmotic pressure changes,decrease of intracellular PH and the formation of oxygen free radicals can cause cell apoptosis and necrosis,injury is typical of the cell change.IRI as a major non-antigen-dependent factor,can cause delayed graft function(DGF)directly,and can also by antigen-dependent factors synergies,cause acute graft rejection(AR)indirectly.AR and DGF are both of the most common complications after kidney transplantation,which impact each other and influence the graft survival rate.So if we can early diagnose the AR and DGF after kidney transplantation,that clinical therapy and intervention can succeed progress in time,which can raise the graft survival rate.But there is not any method for early and accurate diagnose AR and DGF after kidney transplantation at present.Renal biopsy and creatinine are frequently used method in hospital;creatinine is easily impact by other factors which sensitivity and specificity is not high.Although renal biopsy is the gold standard for diagnosis for kidney disease,but a biopsy is an invasive diagnostic technique,the recovery of renal function after renal transplantation,which requires other noninvasive indicators to make a specific diagnosis.Because of the innovative of trial techniques,such as proteomics used in clinical trials, we found several new biological markers can be used monitoring renal function after renal transplantation include:neutrophil gelatinase-associated apolipoprotein(NGAL) and interleukin-18(IL-18).[Objective]To investigate NGAL and IL-18 concentration of the urine in the first day after kidney transplantation,whether predicting AR and DGF.[Method]Since 2006.11.23 to 2007.12.01 Zhejiang University First Affiliated Hospital of kidney disease centre to a total of 138 cases of renal transplant operation.Experimental samples is collected renal transplant patients 52 cases which urine sample was collected and living donor of kidney transplantation(as a healthy control group)8 cases.Collected the urine the first day of recipients after renal transplant and health controls one day before operation,the urine NGAL and IL-18 concentrations were measured by ELISA.According to postoperative urinary creatinine values,pathological findings and clinical condition,patients will be divided into five groups:1,Immediate graft function after cadaveric renal transplantation group(C/I,n = 28):cadaveric renal transplantation recipient,the large decline in serum creatinine values 70%,found no rejection,infection,obstruction,and other postoperative complications after seven days of renal transplantation.2,Living related renal transplantation recipient(L/I,n = 12):living related renal transplantation recipient,the large decline in serum creatinine values 70%,found no rejection, infection,obstruction,and other postoperative complications after seven days of renal transplantation.3,Delayed graft function after renal transplantation group(DGF,n= 5):require hemodialysis treatment or did not require hemodialysis but the serum creatinine value is still more than 400μmol/L after seven days of renal transplantation,excluding,non-renal factors(such as high-capacity,hyperkalemia, etc.)affecting patients.4,Acute allograft renal rejection group(AR,n=7):clinical or pathological diagnosis of allograft renal rejection 7 days after renal transplantation.5, Healthy control group(n=8):Living related renal transplantation donor as healthy controls.To avoid the impact of subjective factors,the groups were divided after the urine NGAL and IL-18 concentrations were detected.[Results]1,The group of basic clinical information:the gender composition,the original disease,postoperative immunosuppressant had no statistical difference,in the living kidney transplantation group age younger than other groups of patients with statistical difference(P＜0.05),other groups of patients between the age were no significant difference.2,The serum creatinine,GFR and the urine concentrations of NGAL and IL-18 between DGF group and the C/I group of are significant differences(P＜0.05)in the first day after renal transplantation.3,The urine concentrations of NGAL and IL-18 between DGF group and the AR group of are significant differences(P＜0.0005)in the first day after renal transplantation.4,The serum creatinine,urine creatinine between AR group and the CAD/I group are statistically significant difference(P＜0.05)in the first day after renal transplantation,the urine concentration of the NGAL and IL-18 between AR group and the C/I group are statistically significant difference(P＜0.0005)in the first day after renal transplantation.5,The cold ischemic time,warm ischemia time,serum creatinine,GFR and the urine NGAL and IL-18 concentrations between L/I group and the C/I group significantly significant difference in the first day after renal transplantation(P＜0.05).[Conclusion]1.NGAL and IL-18 have better sensitivity and specificity for predict DGF and AR after kidney transplantation,which can be used as candidate indicators for clinical diagnosis.2.Further confirmed NGAL is not only the diagnosis indicator, but also has protect function of the kidney,which confirmed the results of animal experiments.3.The renal function is immediate graft function,delayed graft function or acute allograft renal rejection after renal transplantation,which is IRI and repair damage dynamic result after kidney transplant.
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