Application Of The Laparoscopic Technique In Living Donor Kidney Transplantation

Objective:To investigate the method of pig laparoscopic transplant nephrectomy and mada a orthotopic renal transplantation model. Study the mechanism and effects of histomorphology and function in pig allografts by Laparoscopic living donor nephrectomy with CO2pneumoperitoneum, understanding the expression changes of transforming growth factor-betal.Methods:40Diannan Small Ear pigs were randomly divided into experimental and control groups, Laparoscopic living donor nephrectomy with CO2pneumoperitoneum for experimental group. Open living donor nephrectomy for control group, two groups underwent orthotopic renal transplantation. Serum creatinine, urine volume and glomerular filtration rate were detected. One month after transplantation, the grafts were removed for histomorphologic analysis, immunohistochemistry, fluorescence quantitative PCR.Results:1. CO2pneumoperitoneum LDN and ODN kidney transplantation model were successfully established, each group had six cases of renal transplantation model. LDN and ODN group serum creatinine and urea nitrogen postoperative3d,7d, respectively:152±16μmmol/L vs126±8μmmol/L,7.26±0.99mmol/L VS2.87±0.39mmol/L;121±5μmmol/L vs89±10μmmol/L,2.87±0.39mmol/L VS1.63±0.38mmol/L (p<0.05). The warm ischemia time of LDN and ODN group was88.67±6.41s VS29.67±10.54s (p<0.05).2. The histopathological observation:LDN, transplanted kidney HE staining showed that renal tubular epithelial cell injury, interstitial edema and inflammatory cell infiltration compared with ODN serious; Periodic Acid-Schiff (PAS) and Masson staining showed that the LDN group of renal allograft rejection reaction of tubular inflammation compared with the ODN group, have no significant differences; Immunohistochemistry results show the LDN group of TGF-?1expression slightly higher than the ODN group (p<0.05).3. Real-time fluorescence quantitative PCR detection LDN transplant kidney of TGF-?1, Smad2, Smad7mRNA expression, LDN, group of TGF-?1, Smad2Ct value than the ODN group respectively were:24.03±0.12VS22.66±0.55,23.75±0.28the VS22.39±0.68(p<0.05), Smad7Ct value24.22±0.75vs25.25±0.25(p <0.05).Conclusion:1. CO2pneumoperitoneum can affect the early graft recovery, but did not result in a negative effect on long-term graft function and pathological changes. LDN in situ small pig kidneys transplanted model was feasible.2. CO2pneumoperitoneum maybe by Smads pathway enhance TGF-?1, and speed up the allgraft fibrosis needs further study.