Background-Uremia is proposed to increase sympathetic nerve activity (SNA) in hemodialysis patients. The aims of the present study were to determine whether reversal of uremia by successful kidney transplantation (RTX) eliminates the increased SNA and whether signals arising in the diseased kidneys contribute to the increased SNA in renal failure. Methods and Results-We compared muscle sympathetic nerve activity (MSNA) in 13 hemodialysis patients wait-listed for RTX and in renal transplantation patients with excellent graft function treated with cyclosporine (RTX-CSA, nϭ13), tacrolimus (RTX-FK, nϭ13), or without calcineurin inhibitors (RTX-Ø, nϭ6), as well as in healthy volunteers (CON, nϭ15). In addition to the above patients with present diseased native kidneys, we studied 16 RTX patients who had undergone bilateral nephrectomy (RTX-NE). Data are meanϮSEM. MSNA was significantly elevated in hemodialysis patients (43Ϯ4 bursts/min), RTX-CSA (44Ϯ5 bursts/min), RTX-FK (34Ϯ3 bursts/min), and RTX-Ø (44Ϯ5 bursts/min) as compared with CON (21Ϯ3 bursts/min), despite excellent graft function after RTX. RTX-NE had significantly reduced MSNA (20Ϯ3 bursts/min) when compared with RTX patients. MSNA did not change significantly with RTX in 4 hemodialysis patients studied before and after RTX (44Ϯ6 versus 43Ϯ5 bursts/min, PϭNS). In contrast, nephrectomy resulted in reduced MSNA in all 6 RTX patients studied before and after removal of the second native kidney. Conclusions-Despite correction of uremia, increased SNA is observed in renal transplant recipients with diseased native kidneys at a level not significantly different from chronic hemodialysis patients. The increased SNA seems to be mediated by signals arising in the native kidneys that are independent of circulating uremia related toxins. (Circulation.
The impact of 3 different reperfusion sequences following orthotopic liver transplantation (OLT) in pigs were evaluated. The reperfusion technique commonly performed is primary portal in order to shorten warm ischemic times (WITs). Experimental and clinical data, usually comparing 2 out of 3 possible reperfusion sequences, provide controversial results. OLT was performed in 24 pigs randomized into 3 groups: primary arterial (A), simultaneous (SIM), and primary portal (P) reperfusion. Hemodynamics were continuously monitored and reperfusion injury and primary graft function were assessed by standard serum parameters, histopathological findings, immunohistochemistry for heme oxygenase 1 (HO-1), and heat shock protein 70 (HSP 70). Aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), and ␥-glutamyl transpeptidase (␥GT) following reperfusion were significantly increased for group A when compared to groups SIM and P. Hemodynamics showed significant differences after reperfusion compared to physiological data; differences in group comparisons were not significant. The bile production/100 g liver/hr was significantly higher for group SIM (1.15 mL) compared to group P (0.66 mL) and group A (0.62 mL). A lthough the first clinical liver transplantations were performed by arterial reperfusion before portal venous declamping, 1 the most common technique used is primary portal reperfusion. This sequence of reperfusion ought to minimize the warm ischemic time (WIT). This approach dates from an area when total ischemic time was limited to 8 hours of storage. With the implementation of University of Wisconsin and Bretschneider (histidinetryptophan-ketoglutarate [HTK]) solutions it became possible to prolong the cold storage beyond 20 hours. 2,3 Despite this and the more frequent use of marginal organs in solid organ transplantation, primary portal reperfusion in liver transplantation has yet not been altered, since most groups fear that a prolonged suturing time before reperfusion will cause a progressive rewarming and an increased injury of the liver graft, resulting in a higher incidence of primary nonfunction.
Patients treated with tacrolimus had significantly higher combined endpoint-free survival rates and lower acute rejection rates with less immunosuppressive medication at 36 months.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.