| BackgroundAcute kidney injury (AKI) is one of the most common complications after liver transplantation (LT), and there are many factors associated with AKI. However, the effects of portal venous hypertention after reperfusion in a small-size liver transplantation on the renal function and intrarenal RI are still unknown. Sevoflurane has anti-inflammation properties, and renal ischemia/reperfusion under sevoflurane anesthesia resulted in drastic improvements in renal function, however, whether sevoflurane anesthesia is safe with regard to renal function in small-size liver transplantation needs further investigation. In this study, we looked at the renal effects of portal venous hypertension in a rat liver transplantation model using 50% or 100% grafts; we investigated the effects of portal venous hypertension on intrarenal RI; we also looked at the renal effects of sevoflurane in a rat liver transplantation model using a small-size grafts to investigate the changes of NGAL level and kidney histology. Materials and Methods:I. Acute renal injury early after reperfusion in a rat liver transplantation model using different size graftsRats were randomly divided into 3 groups:Sham group (without liver transplantation, other interventions are same); 50%-size group (50%-LT group); total grafts LT group (100% LT group). Six rats in each group were used for the hemodynamic study; Six rats were sacrificed 30min or 2 h after reperfusion. We harvested kidneys and serum for further analysis, including histological and functional parameters; TNF-a, IL-6, NGAL, Cys immunoassay; expressions of MPO and MDA activity in renal tissues.II. Intrarenal RI changes during operation in a rat liver transplantation modelRats were randomly divided into 4 groups:Sham group; anhepatic stage group (only for measuring the right renal RI after clamping the IVC); 50% LT group and 100% LT group (for measuring the right renal RI immediately after reperfusion). Six rats in each group were studied.III. Sevoflurane anesthesia improves against acute renal injury in small-size liver transplantation using rat modelsSixty male Sprague-Dawley rats were randomly divided into 2 groups after 50% size liver transplantation. Rats were anesthetized with chloral hydrate or with sevoflurane and subjected to liver transplantation. Twelve rats in each group were used for the survival study and 6 rats were used for the hemodynamic study. Six rats in each group were sacrificed 2 or 24 h after reperfusion. We harvested kidneys and serum for further analysis, including histological and functional parameters; TNF-?, IL-6 and NGAL immunoassay; expressions of myeloperoxidase (MPO) activity; and NF-kB in renal tissues.The urine was collected 2h after reperfusion for inorganic fluoride measurement. Results:1. Portal vein pressure was observed in the first 50min after reperfusion,and the datas in the 50% LT group were higher than those in the 100% LT group (P?0.05).Rats in the 100% LT group had significantly lower sCr,NGAL,Cys 30min,2h after reperfusion compared with those in the 50% LT group (P?0.05). Rats in the 100% LT group had significantly lower plasma TNF-a and IL-6 concentrations and reduced MPO,MDA concentrations 2 h after reperfusion compared with those in the 50% LT group (P?0.05).Epithelial necrosis in the 50% LT group (4.2±1.2) was greater than that in the 100% LT group 2h after reperfusion (1.7±0.9; p<0.05).2. The right intrarenal RI values increased significantly 10min,15min after clamping IVC compared with baseline (P?0.05); The right intrarenal RI values decreased significantly 5 min,10 min,15min,20 min after reperfusion compared with baseline (P?0.05); the right intrarenal RI values in the 50% LT group were lower compared with those in the 100% LT group 5 min,10 min,15min after reperfusion (P?0.05).There was no significantly correlation between the RI and Cys 30min after reperfusion (r=0.45 P=0.06); there was significantly correlation between the RI and TNFa 30min after reperfusion (r=0.67 P=0.02).3. Rats in the sevoflurane group had significantly lower sCr 24 h after reperfusion compared with those in the chloral hydrate group. Rats in the sevoflurane group demonstrated significantly reduced NGAL concentrations compared with rats in the chloral hydrate group 2 h after reperfusion. Epithelial necrosis in the chloral hydrate group (3.2±0.8) was greater than that in the sevoflurane group (1.5±1.1; p< 0.05). Sevoflurane anesthesia resulted in significantly lower plasma TNF-?and IL-6 concentrations and reduced MPO concentrations 2 h after reperfusion (p< 0.05). NF-kB protein levels 2 h after reperfusion increased by at least 110% in the chloral hydrate group relative to the sevoflurane group 2 h after reperfusion (p<0.05). However, the urine inorganic fluoride concentrations increased significantly (p< 0.001) 2 h after reperfusion in the sevoflurane group (6.1±1.5?mol/1) compared with the chloral hydrate group.Conclusions:1. The portal venous pressure increased significantly early after reperfusion in the 50% LT group,and AKI was severe in the early after operation.The system and intrarenal inflammatory response were severe in the 50% LT group early after reperfusion.2. The right intrarenal RI values increased significantly during anhepatic stage,and decreased significantly early after reperfusion compared with baseline. The right intrarenal RI values in the 50% LT group were lower compared with 100% LT group.The decline in RI values might be associated with portal hyperpressure and increased TNFa release after reperfusion in the 50% LT group.The decline in RI early after reperfusion can't improve the renal function.3. Sevoflurane anesthesia can attenuate renal injury and modulate inflammatory cascades in small-size liver transplantation using rat models. Although sevoflurane anesthesia can increase the urine inorganic fluoride concentrations, sevoflurane is still safe with regard to renal function. |
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