The Early Changes Monitoring In Vivo Renal Transplantation By Microdialysis

Backgrounds:Chronic renal function failure(CRF)is a progressive and fatal disease.Renal all transplantation has become an accepted means of treating humans with chronic renal failure.When successful,a renal allograft may offer the recipient an improved quality of life and extended lifespan.But the long-term prognosis of a kidney transplantation patient is highly dependent on recipient acceptance of the allograft.Rejection of the donor kidney is a common complication.Failure to identify early graft rejection may result in the irretrievable loss of the organ and damage to the graft may be substantial prior to the onset of clinical and biochemical abnormalities.There is currently no single clinical, biochemical,or diagnostic imaging test to diagnose renal allograft rejection or to differentiate rejection from other disease processes of the allograft.Recently,increased lipolytic activity has mainly been studied by measuring phospholipids extracted from tissue homogenate samples in animal models of ischemia,hypoxia,hypoglycemia and epilepsy. Interstitial glycerol harvested by microdialysis seems to be a marker for monitoring of membrane lipolysis.Graft rejection leads to cell injury after renal transplantation.Under this circumstance,it is important to monitor the changes of glycerin in intercellular fluid of graft.The.level of blood lactate may be useful for evaluating anoxic tissue and reflect non-specificity oxidative lesion.During the reject reaction,lactate may reflect early changes of graft.Methods:There are nine patients in this clinical experiment.Before the operation is over,we put amicrodialysis catheter upper pole and in lamina cortex of the graft.External part of microdialysis catheter link to a minipump with fulling load of iso-osmia dialysate.At the same time,we put the same microdialysis catheter in abdominal subcutance,consecutive serial samples are collected at 1-hintervals after the operation,glucose, lactate,pyruvate and glycerol concentrations are measured.At the same time,patients do some routine examination and are observed continually. In this clinical empirical study,clinical medications are let alone. Lactate concentration below 2mmol/L is normal and exceeding 2mmol/L is abnormal.Results:Urea nitrogen post-operative quickly decrease from 16.73±5.77 mmol/l to 8.68±3.39mmol/l(p＜0.05).Urea nitrogen maintain 6-8mmol/l of normal level.Carnine post-operative quickly decrease from 984.2±244.?9ummol/l to 283.06±102.99ummol/l(P＜0.05).Carnine maintain 120-200ummol/l of normal level.The glycerin in graft obviously is lower than in subcutance(P=0.000). Nonage of post-operative,the glycerin in subcutance obviously increase from 140.73±52.35umol/L to 672.57±194.62umol/L and maintain 19 hours. At 57^thhours,the glycerin in subcutance emergence thesecond time heightening.At thesame time,the glycerin in graft heighten.The glycerin in graft do not duplicatly heightened after operation. The range is from 69.54±19.36umol/L to 318.93±105.94umol/L ummol/l. The glycerin of every other one hour comparation is not statistical significance(P＞0.05)In our study,lactate and glycerin of the graft have better correlation (R=0.289,P=0.000).All patients including normal group(86.21±31.65) umol/L and abnormal group(204.37±77.76)umol/L,glycerin of the graft in abnormal obviously exceed normal group(P=0.000).Conclusion:Microdialysis method allows continuous bedside monitoring the changes of metabolism in the graft.After renal transplantation of relatives in vivo,the glycerin in graft maintains stable level and has no dupilicatily increasing.With the increasing of lactate,the glycerin in graft also increases. It is damage for the increasing concentration of lactate.