Trabajo presentado en el 12th EPITA Symposium - 41st AIDPIT Workshop, celebrado en Austria, del 22 al 24 de enero de 2023Background: The vascular endothelium is critically involved in many steps of tissue damage originating during ischemia-reperfusion (IR) in human transplantation. An endothelial surface layer, the glycocalyx, forms the primary interface between the blood and the healthy endothelium and its shedding is recognized as a cornerstone in IR-related endothelial dysfunction. We investigated the role of endothelial glycocalyx breakdown products in patients undergoing pancreas transplantation.
Methods: Endothelial integrity and remodelling products were measured in plasma from 26 simultaneous reno-pancreas transplants and 2 re-transplants recipients. The levels of syndecan-1, hyaluronan, heparan sulfate and Vascular Endothelial Growth Factor (VEGF) were determined using enzyme-linked immunosorbent assay at different time points: before surgery, 10 minutes and 24 hours after reperfusion, and at patient discharge.
Results: Transplant recipients had greater evidence of glycocalyx damage 10 min. after reperfusion of the graft as compared before surgery, measured by plasma levels of syndecan-1 (66.54 vs 155ng/mL; p<0.0001) and heparan sulfate (4.96 vs 6.07 ng/mL, p=0.0435) components. However, plasma hyaluronan levels remained unchanged throughout. The levels of VEGF significantly decreased in plasma 10 min. after graft reperfusion (117 vs 18 pg/mL; p<0.0001). No correlation existed between endothelial markers except for syndecan-1 with VEGF and heparan sulfate at this time point, respectively (r=0.395, p=0.0371; r=0.572, p=0.001). Regression analysis showed that the higher levels of syndecan-1 were more frequent in patients with acute rejection (p=0.011), intestinal complications (p=0.045) and those who developed kidney surgical complications (p=0.026) or needed for a urological reintervention (p=0.024). Graft pancreatitis and pancreatic fistulas were associated with the levels of hyaluronan at 24h post-reperfusion (p=0.04; p=0.04, respectively) and at patient discharge (p=0.012; p=0.012, respectively).
Conclusions: This study provides the first evidence for endothelial glycocalyx damage in pancreas transplantation. Further studies are needed to validate these findings in a larger sample size
