Effect Of Ulinastatin On Early Postoperative Renal Function Recovery In Renal Transplantation Of Donor Kidney After Controlled Cardiac Death

Objective:To observe the effect of ulinastatin on the recovery of renal function in patients undergoing kidney transplantation after controlled cardiac death.Methods:Sixty patients（ASA Ⅲ-Ⅳ）who received DCD donor kidney transplantation in the First Hospital of Jilin University from December 2020 to June 2021 were selected.All cases were approved by the Medical Ethics Society of the hospital,and informed consent was signed with family members and patients for operation and anesthesia prescription.Patients were randomly divided into two groups.In C1 group（ulinastatin group）,the dose of10000IU/kg ulinastatin was dissolved in 0.9% sodium chloride injection to50 m L,and intravenous pumping was started at the time of renal vein anastomosis until the end of surgery.C2 group（control group）received 0.9%sodium chloride injection 50 m L intravenously at the same time point until the end of operation.Urine volume was recorded 24 hours a day 1-7 days postoperatively,daily creatinine and urea nitrogen levels 1 day preoperatively and 1 to 7 days postoperatively,and daily glomerular filtration rate was estimated.Results SPSS26.0 software was used for statistical analysis.Results:Comparison of patients’ general data:gender,age,height,weight,body mass index,dialysis time,operation time and intraoperative fluid infusion volume had no statistical significance（P>0.05）;There was no significant difference in mean arterial pressure（MAP）at different intraoperative time points between 2 groups（P>0.05）.There was no significant difference between hot ischemia time and cold ischemia time of transplanted kidney（P>0.05）.The24-hour urine volume of patients in both groups on the 7th day after surgery showed a trend of further decline after the urine volume of patients in C1 group and C2 group peaked on the 2nd and 3rd day,respectively.On the 2nd,4th and6 th day after surgery,the 24-hour urine volume of patients in C1 group was higher than that of patients in C2 group,and the comparison of 24-hour urine volume between the two groups showed statistical significance（P<0.05）.In the remaining 3 days,there was no significant difference in 24-hour urine volume between the two groups（P>0.05）.Serum creatinine levels in both groups decreased significantly within 1 week after surgery,but the degree of decrease in ulinastatin group was greater than that in control group,but there was no statistical correlation（P>0.05）.Estimated glomerular filtration rate（e GFR）in the ulinastatin group was higher than that in the control group 1 week after surgery,and e GFR in the C1 group was higher than that in the C2 group on the3 rd postoperative day（P<0.05）.However,there was no statistical correlation between e GFR between 2 groups on the remaining days（P>0.05）.Within 1week after surgery,blood urea nitrogen levels in both groups showed a trend of early decline and later increase,among which,blood urea nitrogen levels in ulinastatin group decreased more significantly than control group,but there was no significant comparison between the two groups（P>0.05）.Conclusion:Continuous intravenous infusion of 10000IU/kg ulinastatin during kidney transplantation of donor kidney after controlled cardiac death has a certain protective trend for early postoperative renal function recovery.