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Ischaemia reperfusion injury (IRI) is inevitable in kidney transplantation and negatively affects patient and graft outcomes. Anaesthetic conditioning (AC) refers to the use of anaesthetic agents to mitigate IRI. AC is particularly associated with volatile anaesthetic (VA) agents and to a lesser extent to intravenous agents like propofol. VA like sevoflurane interferes with many of the processes underlying IRI and exerts renal protective properties in various models of injury and inflammation. We hypothesise that a sevoflurane-based anaesthesia is able to induce AC and thereby reduce post-transplant renal injury, reflected in improved graft and patient outcome, compared with a propofol-based anaesthesia in transplant recipients of a deceased donor kidney.
Investigator-initiated, multicentre, randomised, controlled and prospective clinical trial with two parallel groups. The study will include 488 kidney transplant recipients from donation after brain death (DBD) or donation after circulatory death (DCD) donors. Participants are randomised in a 1:1 design to a sevoflurane (intervention) or propofol (control) group. The primary endpoint is the incidence of delayed graft function in recipients of DCD and DBD donor kidneys and/or 1-year biopsy-proven and treated acute rejection. Secondary endpoints include functional delayed graft function defined as failure of serum creatinine levels to decrease by at least 10% per day for three consecutive days; primary non-function is defined as a permanent lack of function of the allograft; length of hospital stay and postoperative complications of all kinds, estimated glomerular filtration rate at 1 week and 3 and 12 months calculated with the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula; readmissions at 3 and 12 months, graft survival and all-cause mortality at 12 months.
The study is approved by the local ethical committees and national data security agencies. Results are expected to be published in 2025.
Introducción. Las heridas crónicas suponen un grave problema de salud con gran impacto socioeconómico debido a su morbimortalidad y a la afectación de la calidad de vida. Desde hace tiempo se conocen las propiedades de los lípidos en el sistema inmunitario. Un sistema inmunológico débil podría conducir a una infección o cronificación de las heridas. El colesterol es un lípido con importancia cuantitativa en las membranas de las células donde contribuye al mantenimiento de la fluidez de membrana. Unos niveles bajos de colesterol se relacionan con mayor riesgo de padecer infecciones. El objetivo del estudio fue analizar los niveles de lípidos en pacientes con úlceras por presión infectadas. Metodología. Se estudiaron 77 pacientes del Departamento de Salud de Elche Hospital General con úlceras por presión infectadas en un periodo de un año. Resultados. Se ponen de manifiesto diferencias estadísticamente significativas entre pacientes con niveles de C-LDL por debajo de 70mg/dL y pacientes con niveles por encima de 70mg/dL que presentan un CT por debajo de 140mg/dL. Discusión. La investigación futura sobre estos aspectos ayudará a aclarar los mecanismos de transporte del colesterol hacia los tejidos para así protegerlos de las agresiones de los microorganismos.
ABSTRACT
Introduction. Chronic wounds are a serious health problem with great socioeconomic impact due to their morbidity and mortality and the affectation of quality of life. The properties of lipids in the immune system have been known for a long time. A weak immune system could lead to infection or chronic wounds. Cholesterol is a quantitatively important lipid in cell membranes where it contributes to maintaining membrane fluidity. Low levels of cholesterol are associated with an increased risk of infections. The objective of the study was to analyze the levels of lipids in patients with pressure ulcers infected. Methodology. 77 patients with infections in pressure ulcers from the Health Department of Elche-General Hospital were studied for one year. Results. Statistically significant differences are revealed between patients with LDL-C levels below 70mg/dL and patients with levels above 70mg/dL. Levels of TC were below 140mg/dL in both groups. Discussion. Future research on these aspects will help clarify the mechanisms of cholesterol transport to the tissues and therefore protect them from microorganism aggressions.
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