Alterations of fibronectin and laminin and expression of matrix metalloproteinases following skeletal muscle ischemia-reperfusion injury

Aims: To investigate alterations in flrbronectin (FN) and laminin (LN) levels, and the expression of associated caseinolytic MMPs in tissues following skeletal muscle (SM) ischemia and reperfusion (VR). Materials and Methods: The rats were subjected to 4 h hindlimb ischemia, followed by reperfusion for 0, 4, 24 or 72 h. Two further groups was administered doxycycline before ischemia was induced. The rats were then sacrificed and samples were processed. ELISA, Immunohistochemical techniques,Zymography and Western blotting were employed. Results: Plasma FN (pFN) decreased following hindlimb ischemia and subsequently increased with reperfusion. FN accumulated in the basement membrane (BM) of SM, whereas degradation occurred in the lungs and kidneys after SM I/R. FN decreased in the liver after SM ischemia and then increased with reperfusion. However, LN was degraded in all BM. Following doxycycline treatment, levels of FN increased in lungs, kidneys, and liver. Degradation of LN was inhibited in all tissues by doxycycline. In addition, a 20 l<Da caseinolytic species was identified in lung tissues, which was inhibited by EDTA and 1,10- phenanthroline, but not inhibited by PMSF. This species was down-regulated by anesthesia only and then up-regulated immediately following bilateral hindlimb yR. An increased production of this MMP was also found after treatment of the rats with doxycycline. Conclusions: FN has a specific affinity to injured tissue, as was minored by rapid depletion of pFN, which was secreted by the liver. Moreover, the degradation of FN in lungs and kidneys and LN in all BM was suggested to be due to the effects of MMPs. In addition, doxycycline reduced the degradation of FN in lungs and kidneys and LN in all tissues studied by inhibiting the activity of MMPs. However, degradation of FN was not evident in SM, because there was an over deposition of FN in SM following VR. Furthermore, a caseinolytic MMP, rather than a serine protease, was involved in lung injury following SM I/R Doxycycline increased the production of this MMP. Although it has not been identified, this MMP was suggested to be a lower molecular weight MMP, possibly MMP-7 or MMP-12. Further study is needed for confirmation of its identity.Thesis (M.S.)--University of Adelaide, Dept. of Surgery, 200

Procurement of Abdominal Organs in Multi-Organ Donation in Deceased Donor

Organ procurement is an essential step for organ transplantation, from which a quality organ is received for subsequent transplantation. As the demand for organ transplantation continues to grow, multi-organ donation including the heart, lung, live, pancreas, kidneys, and small intestine from one potential donor is always a priority to meet the demand. The donor is generally rigorously assessed for suitability of organ donation prior to proceeding to organ procurement. The quality of the organ from multi-organ procurement is usually satisfactory without jeopardizing its transplantation. In this chapter, the surgical technique for procurement of the organs from the abdomen is described. Some alternative techniques have also been discussed. Some pictures are inserted to facilitate understanding of the surgical procedure

Page Kidney Phenomenon following Kidney Graft Biopsy

Percutaneous renal allograft biopsy is commonly performed as a protocol or diagnostic biopsy after kidney transplantation to detect rejection, recurrence of kidney disease, infection and calcineurin inhibitor (CNI) nephrotoxicity [1,2]. It is generally considered as a safe procedure under ultrasound guidance. However, some complications associated with this procedure can occur. Most common complications are minor and can be managed conservatively. Major complications can occur in about 1% of cases [3,4], which may require blood transfusion, interventional procedure or even surgical exploration. Page kidney phenomenon is one of the rare but serious complications, in which the renal parenchyma is tamponade and its perfusion is compromised as a result of haematoma formation under the renal capsule. This will lead to deterioration in kidney function and graft loss if the diagnosis and management are delayed [5]. Therefore, early recognition of page kidney phenomenon is crucial as prompt evacuation of the haematoma can prevent graft loss and allow complete recovery of renal function [6]. Here we reported two cases of page phenomenon after kidney graft biopsy in our institution. The literatures were also reviewed

Dual Kidney Transplant: Clinical Experience and Overview of Surgical Techniques

Background: Dual Kidney Transplant (DKT) of marginal kidneys has expanded utilizing the extended criteria donor (ECD) organs. The aim of this study is to report the outcomes of dual kidney transplant in our institute and review the surgical techniques of DKT in the Literature.Materials and Methods: Between Jan 1999 and April 2014, 10 cases (8 male and 2 female; mean age 50 years) of DKT were performed in our institute. The surgical techniques include unilateral incision for 9 patients, a midline incision for 1 patient. The literature was reviewed for surgical techniques of DKT.Results: Two recipients had DKT as an En bloc from pediatric donors, whereas others had DKT from elderly donors. The mean surgical time was 5 hours 4 min (Range: 3 hours 40 min to 6 hours 24 min). Two patients had a complication of lymphocele and subsequent development of ureteric stricture. There was no vessel thrombosis and no urine leakage in this cohort. The creatinine level was 137 (±37.4) μmol/L at 12 months follow-up. The various techniques were described in the literature.Conclusion: DKT is an established technique for expanding use of extended criteria of kidney donors. The clinical outcome is satisfactory and surgical complications can be minimized. Based on our experience in a small series, vascular complication can be prevented with caution during vessel anastomosis and position of the kidney grafts. The single site placement of DKT is preferred from the literature review.</p

Laparoscopic donor nephrectomy: meeting the challenge of consumerism?

Mark Siddins, Gabrielle Hart, Bulang He, Burapa Kanchanabat, M. Mohan Ra