Bootcongres

Introduction Delayed graft function and primary non-function are serious complications following transplantation of kidneys derived from deceased brain dead (DBD) donors. α-melanocyte stimulating hormone (α-MSH) is a pleiotropic neuropeptide and has been demonstrated to have renoprotective effects in models of acute kidney injury. We hypothesized that α-MSH treatment of the recipient improves early graft function and reduces inflammation following DBD kidney transplantation. Material & Methods Eight Danish landrace pigs served as DBD donors. After four hours of brain death both kidneys were removed and stored for 18 hours at 4°C in Custodiol® preservation solution. Sixteen recipients were randomized in a paired design into two treatment groups transplanted simultaneously. α-MSH or vehicle was administered at start of surgery, during reperfusion and two hours post-reperfusion. The recipients were observed for ten hours following reperfusion. Blood, urine and kidney tissue samples were collected during- and at the end of follow-up. Glomerular filtration rate (GFR) was defined as 51Cr-EDTA renal clearance. Results α-MSH treatment reduced urine flow and impaired recovery of glomerular filtration rate (GFR) compared to controls. After each dose of α-MSH a trend towards reduced mean arterial blood pressure and increased heart rate was observed. α-MSH did not affect gene expression of inflammatory markers. Thirty minutes post-reperfusion α-MSH increased plasma aldosterone levels. 

Discussion Surprisingly, α-MSH impaired recovery of renal function in the first ten hours following DBD kidney transplantation. This is explained by activation of the renin-angiotensin-aldosterone system due to hemodynamic instability. Thus, in a porcine experimental model α-MSH did not reduce renal inflammation and did not improve short-term graft function following DBD kidney transplantation.