Téma: 

N-acetylcystein (nac) administered in organ donors before cerebral panangiography as prevention of contrast nephropathy

Juraj Miklušica, Ľudovít Laca, Barbara Grandtnerová, Hubert Poláček, Marek Adámik, Michal Hošala, Blažej Palkoci

Aims: To evaluate influence of NAC administration before cerebral angiography (AG) in brain death donors on subsequent kidney graft function. Patients and methods: We evaluated all organ donors and kidney transplant recipients from 1st of June 2003 to 31st of December 2007. Organ donors were divided into 3 groups: group A (n = 19) – cerebral AG without NAC, group B (n = 37) – 600 mg of NAC administrated IV immediately before AG, group C (n = 24) – clinical determination of brain death only. Mean age was 44 ± 2.9 vs. 40.7 ± 2.5 vs. 41.8 ± 3 years (p = ns), best glomerular filtration rate (GFR) (Cocroft – Gault formula) 2.0 ± 0.18 vs. 2.27 ± 0.11 vs. 1.67 ± 0.11 ml/s (B vs. C p < 0,01), S-Na before harvesting 147 ± 3 vs. 143 ± 1 vs. 144 ± 2 mmol/l (p = ns). Kidney recipients were divided into 3 groups corresponding with their donors. Mean age was 44.5 ± 2.8 vs. 49 ± 1.6 vs. 47.8 ± 2.3 years (p = ns), cold ischemia time 883 ± 56 vs. 768 ± 63 vs. 703 ± 69 min. (p = ns), median compatibility index 9.5 vs. 13 vs. 12 (p = ns). Extent of glomerular sclerosis, tubular atrophy, interstitial fibrosis and arteriolar hyalinosis in zero biopsies were comparable between all groups. Neither the numbers of delayed graft function nor rejection episodes were significantly different. Results: After transplantation, we found significant differences in 24-hour creatinine clearance corrected for body surface area between 3 groups of recipients. At day 7: CrCl was 0.49 ± 0.08 vs. 0.87 ± 0.08 vs. 0.94 ± 0.1 ml/s (p < 0,01); at the 1st month: 0.72 ± 0.05 vs. 0.93 ± 0.07 vs. 1.14 ± 0.1 ml/s (p < 0.01); at the 3rd month: 0.75 ± 0.07 vs. 0.97 ± 0.05 vs. 1.19 ± 0.07 ml/s (p < 0.001) and at one year (group A and B available only): 0.84 ± 0.09 vs. 1.26 ± 0.13 (p < 0.05). Conclusion: Our results suggest that kidney graft function up to one year after transplantation was significantly better if brain death donors were pre-treated with NAC before cerebral angiography. However, kidney graft function from donors pre-treated with NAC was still slightly worse that from donors with clinical determination of brain death only.

Ročník 2008  Témy časopisu Clinical urology 2 / 2008

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