Saudi Journal of Kidney Diseases and Transplantation

LETTER TO THE EDITOR
Year
: 2009  |  Volume : 20  |  Issue : 2  |  Page : 290--291

Protective effect of pentoxifylline in the kidney perfusion fluid on the transplanted kidney


Alireza Hamidian Jahromi1, Nicos Kessaris2, Maryam Sharifian3, Jamshid Roozbeh3,  
1 Renal Transplant Department, St. Georges Hospital, London, UK; Nemazee Hospital Organ Transplantation Unit, Shiraz University of Medical Sciences, Shiraz, Iran
2 Renal Transplant Department, St. Georges Hospital, London, UK
3 Nemazee Hospital Organ Transplantation Unit, Shiraz University of Medical Sciences, Shiraz, Iran

Correspondence Address:
Alireza Hamidian Jahromi
Renal Transplant Department, St. Georges Hospital, London, UK; Nemazee Hospital Organ Transplantation Unit, Shiraz University of Medical Sciences, Shiraz, Iran




How to cite this article:
Jahromi AH, Kessaris N, Sharifian M, Roozbeh J. Protective effect of pentoxifylline in the kidney perfusion fluid on the transplanted kidney.Saudi J Kidney Dis Transpl 2009;20:290-291


How to cite this URL:
Jahromi AH, Kessaris N, Sharifian M, Roozbeh J. Protective effect of pentoxifylline in the kidney perfusion fluid on the transplanted kidney. Saudi J Kidney Dis Transpl [serial online] 2009 [cited 2020 May 29 ];20:290-291
Available from: http://www.sjkdt.org/text.asp?2009/20/2/290/45583


Full Text

To the Editor,

Kidney transplantation is the preferred me­thod of renal replacement therapy for patients with end-stage renal disease. Transplantation is, however, a victim of its own success with demand for organs far exceeding supply. The availa-bility of organs from cadaveric heart­beating donors has declined over the past years due to reasons such as reduction in death associated with road traffic accidents and intracranial hemorrhage. [1] One way of expan­ding the donor pool is to use organs retrieved form non-heart beating donors. [1] The main difference between retrievals from heart beating and non-heart beating donors is the uncontrolled situation associated with non­heart beating donor retrival and the duration of "warm ischemia time". This is the time bet­ween occurrence of donor asystole and co­mmencement of perfusion of the kidney with cold preservation fluid. This asystolic warm period does not occur in heart beating donors.

Machine perfusion has come to use to pre­serve donated kidneys since the 1970s. How­ever, the practice was replaced by the successful development of "cold static sto­rage", which had the advantage of being sim­pler and cheaper when also an effective alter­native. [1] As the number of heart beating do­nors decreased and the kidneys were increa­singly sought from non-heart beating donors (and thereby exposed to longer warm ischemia time), and also with increasing use of marginal organs and better understanding of the conse­quences of ischemia-reperfusion injury, inte­rest in machine perfusion has returned in an attempt to enhanced organ preservation. Diffe­rent solutions have been used in static cold preservation and machine perfusion preser­vation of the kidney grafts retrieved from heart beating as well as non-heart beating donors.

Pentoxifylline (PTX) is a methylxanthine phos­phodiesterase inhibitor with multiple hemo­rheologic properties. It is commonly used to treat peripheral vascular disease. PTX improves oxygen delivery to ischemic tissues through increasing intracellular cyclic-AMP in red blood cells, increasing cyclic-AMP in poly­morph nuclear cells and decreasing production of oxygen free radicals. [2],[3]

There is also evidence that "PTX has free ra­dical-scavenging properties." [3] It has been shown to decrease the production of pro-inflamma­tory cytokines and reactive oxygen species as well as to reduce the toxic effects of cyclos­porine. [4],[5] In addition, PTX is thought to limit the inflammatory response with a reduction in cellular activation, phagocytosis and endothe­lium adhesion. Moreover, there is evidence that PTX reduces the destruction of nitric oxide. [3] PTX has been used in the flush solution in lung transplants in animal studies and has been proposed to improve early lung graft function and reduce reperfusion injuries. [6],[7]

Ischemia-reperfusion injury is a biphasic com­plex phenomenon that induces cell damage. The first phase is ischemia. This initiates the tissue injury by causing energy deprivation, which is essential for cellular homeostasis and may ultimately lead to cellular dysfunction and death. Reperfusion, the second and more important phase, exacerbates this damage by induing a cascade of inflammatory reactions involving oxygen-free radicals, endothelial fac­tors and leukocytes.

This process ultimately disrupts the delicate balance that maintains homeostasis in the microcirculation. The subsequent inflammatory reaction causes local tissue destruction by the release of proteases and oxygen-free radicals.

As PTX seems to antagonize a number of steps in this process, we hypothesize that it has a protective effect on the transplanted kidney by reducing the severity of the ischemia­reperfusion injury when added to the perfusion fluid. Adding PTX to the machine perfusion fluid in the kidney transplant has not been proposed before. This might result in better as well as longer kidney survival.

References

1Final Scope for the appraisal of machine perfusion systems and cold static storage of donated kidneys. National Institute for Health and Clinical Excellence July 2006.
2Stafford-Smith M. Evidence-based renal pro­tection in cardiac surgery. Semin Cardiothorac Vasc Anesth 2005;9(1):65-76.
3Davila-Esqueda ME, Martinez-Morales F. Pentoxifylline diminishes the oxydative damage renal tissue induced by streptozotocin in the rat. Exp Diabesity Res 2004;5:245-51.
4Demir E, Paydas S, Balal M, Kurt C, Sertdemir Y, Erken U. Effects of pentoxifylline on the cytokines that may play a role in rejection and resistive index in renal transplant recipients. Transplant Proc 2006;38(9):2883-6.
5Noel C, Hazzan M, Labalette M, et al. Improvement in the outcome of rejection with pentoxifylline in renal transplantation: A randomized controlled trial. Transplantation 1998;65(3):385-9.
6Yamashita M, Schmid RA, Okabayashi K, et al. Pentoxifylline in flush solution improves early lung allograft function. Ann Thorac Surg 1996;61(4):1055-61.
7Okabayashi K, Aoe M, DeMeester SR, Cooper JD, Patterson GA. Pentoxifylline reduces lung allograft reperfusion injury. Ann Thorac Surg 1994;58(1):5-6.