Authors: T Iwata A Gilispie C Jorns S Yamamoto G Nowak BG Ericzon
Publish Date: 2007/08/19
Volume: 22, Issue: 4, Pages: 938-942
Abstract
Laparoscopic donor nephrectomy has become the first choice for living donor kidney transplantation offering advantages over open donor nephrectomy This study aimed to evaluate kidney tissue metabolism during and after pneumoperitoneum using a microdialysis techniqueEight pigs underwent laparotomy and implantation of two microdialysis catheters one in the cortex and one in the medulla of the left kidney After laparotomy the abdominal wall was closed and pneumoperitoneum was induced with a constant standard pressure of 16 to 18 mmHg for 4 h followed by rapid desufflation In microdialysis samples collected from intrarenal catheters markers of ischemia glucose lactate pyruvate and lactate–pyruvate ratio and the marker of cell membrane injury glycerol were monitoredThere were no changes in glucose lactate or pyruvate level before during or after pneumoperitoneum either in the cortex or in the medulla Additionally the calculated lactate–pyruvate ratio did not show signs of ischemia during or after pneumoperitoneum However with regard to the marker of cell injury glycerol increased in the medulla after decompression from 2257 ± 376 to 3567 ± 543 mmol/l p 001 This release of glycerol in the medulla was significantly higher than in the cortex area under the curve AUC 2218 ± 487 vs 3479 ± 788 mmol/l p 001The pattern of metabolic changes monitored in the kidney during and after pneumoperitoneum indicates some kind of cell injury predominant in the medulla without any signs of kidney ischemia This nonischemic injury could be related to hyperperfusion of the kidney after decompression or injury to cells attributable to mechanical cell expansion at the point of rapid decompression
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