Transplanted Kidney Ischemia Reperfusion Injury
Conditions
Keywords
ischemia, reperfusion, kidney, transplantation
Brief summary
The aims of this study are: 1. assessment of ischemia injury of kidney retrieved from standard and expanded criteria deceased donor before transplantation 2. assessment of efficacy of kidney ischemia injury decreasing 3. assessment of influence of kidney ischemia injury decreasing on its function after transplantation For the purpose of this research one hundred kidney will be retrieved from deceased donors (standard and expanded criteria deceased donors) for transplantation. All kidneys before transplantation will be stored in machine perfusion in hypothermia with continuous flow - Organ Recovery Systems LifePort - each single kidney in self-contained perfusion system. For the kidney allograft assessment will be used measurements performed during machine perfusion in hypothermia: renal flow, resistance, lactate dehydrogenase, lactates and ischemia injury markers measured in the fourth hour of perfusion in perfusion fluid. For kidney ischemia injury assessment such markers will be measured: tumour necrosis factor (TNF alfa), interleukin 2 (IL-2), interleukin 6 (IL-6), high sensitivity C-reactive protein (hsCRP), platelet-derived growth factor (PDGF), cystatin C, kidney Injury Molecule (KIM-1), neutrophil Gelatinase-associated Lipocalin (NGAL), complement component C3, caspase 3. Every time from pair of retrieved kidneys each kidney will be randomise for one of the group: * group 1) - 50 kidneys - examined group - cured with etanercept (ENBREL) in the first hour of perfusion by adding drug to perfusion fluid, * group 2) - 50 kidneys - control group - without intervention. Ischemia injury markers will be measured in perfusion fluid by kidney two times (in the first and fourth hour of perfusion) for assessment of efficacy kidney ischemia injury decreasing. Results of measurements of kidney ischemia injury before transplantation, parameters during machine perfusion in hypothermia and donor parameters will be correlated with kidney allograft function post transplantation. Immediate, delayed and slow graft function, primary non-function, kidney function assessed by creatinine concentration and creatinine clearance at one day, seven days, two weeks, 1, 6 and 12 months post transplantation and kidney graft survival 6 and 12 months post transplantation will be analysed.
Interventions
DRUGetanercept
adding appropriate dose of etanercept to the perfusion fluid
Sponsors
Medical University of Warsaw
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Caregiver, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
DONOR STAGE * donor after brain death * seronegative HCV (hepatitis C virus) * procurement of two kidneys from the same donor * donor center distance up to 220 kilometres from Warsaw * availability of fluid KPS-1 and cartridge of Organ Recovery System RECIPIENT STAGE * recipient of kidneys from deceased donor * at least eighteen recipient * expression of informed consent
Exclusion criteria
DONOR STAGE * live kidney donor * seropositive HCV (hepatitis C virus) * get only one from the kidneys * doubtful donor - e.g. need for biopsy because of proteinuria or due to histological lesions (e.g. tumor) * donor center distance above 220 kilometres from Warsaw * lack of fluid KPS-1 and cartridge of Organ Recovery System RECIPIENT STAGE * recipient of kidney form living donor * minor recipient * no expression of informed consent * multiple organ recipient * recipient EN BLOC kidneys or two kidneys * recipient of kidney from donor under 14 years old * a need of atypical urinary diversion in kidney recipient * participation in another study at least in the last 30 days
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| delayed graft function | one week | a need at least one dialysis during first week after transplantation |
| 12 months graft survival | 12 months | survival of kidney grafts 12 months after transplantation |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| acute rejection | 12 months | biopsy proven acute rejection episodes during the first year after transplantation |
| kidney ischemia injury assessment | 4 hours | ischemia injury markers measured two times (in the first and fourth hour of perfusion) in perfusion fluid: tumour necrosis factor (TNF alfa), interleukin 2 (IL-2), interleukin 6 (IL-6), high sensitivity C-reactive protein (hsCRP), platelet-derived growth factor (PDGF), cystatin C, kidney Injury Molecule (KIM-1), neutrophil Gelatinase-associated Lipocalin (NGAL), complement component C3, caspase 3 |
Countries
Poland
Outcome results
None listed