Transplantation proceedings
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Comparative Study Observational Study
Is urinary γ-glutamyl transpeptidase superior to urinary neutrophil gelatinase-associated lipocalin for early prediction of acute kidney injury after liver transplantation?
In this prospective study, we comparatively evaluated the accuracy of several biomarkers of acute kidney injury (AKI) on predicting its occurrence after liver transplantation (LT). The parameters evaluated were urinary tubular enzymes (γ-glutamyl transpeptidase [γGT], alkaline phosphatase, and urinary lactate dehydrogenase) and urinary neutrophil gelatinase-associated lipocalin. These parameters were evaluated both as isolated variables and divided by urinary creatinine. ⋯ Urinary neutrophil gelatinase-associated lipocalin was not as accurate; the best predicted value for this parameter was absolute value at D1 with an area under the curve of 0.5 (specificity, 84.2%; sensitivity, 35.7%; cutoff value, 44.6 ng/mL). We concluded that the absolute value of urinary γGT evaluated at the end of LT was the most accurate parameter to predict AKI in our cohort. Urinary enzyme levels must be taken into account in future analysis of this issue.
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Successful organ donation in countries adopting informed consent legislation depends on adequate interviewing of potential donors' families. As the number of both referral and effective donors in Brazil increases, health care managers argue whether educational efforts should be directed toward training in-hospital coordinators (IHC)--based on the "Spanish model"--or on the creation of extra-hospital-based professionals (Organ Procurement Organizations [OPOs], the "American model"). Meanwhile, many potential donor families are still approached by intensive care unit (ICU) professionals not trained in donation interviews. ⋯ Our results show that adequate professional training is necessary for obtaining family consent for organ donation. Both established international policies for organ procurement and donation, namely the "Spanish model" with its IHCs or the "American model" of extra-hospital OPOs, may equally achieve this task. However, family interviews performed by untrained ICU professionals result in low donation rates and should be discouraged.
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The aim of this study was evaluate the beta blocker atenolol (AT) and ischemic preconditioning (IPC) strategies for tissue protection against systemic effects of intestinal ischemia (I) and reperfusion (R) injury. Forty-two rats were pretreated with AT (1.5 mg · kg(-1)), 0.9% saline solution (SS; 0.1 mL), or IPC and then subjected to prolonged occlusion of the superior mesenteric artery for 60 minutes leading to I followed or not by 120 minutes of R, according to the group. For IPC, 5 minutes of I prior to 10 minutes of R were established. ⋯ Histologic analysis showed an important inflammatory infiltrate in the I-R + SS (I-R + SS = 4.5), which was significantly (P < .05) reduced by IPC (I-R + IPC = 3.0) or AT (I-R + AT = 3.0). Likewise, the TBARS levels were decreased by both strategies (I-R + SS = 0.63; I-R + IPC = 0.23; I-R + AT = 0.38; P < .05). Our results showed that AT and IPC attenuate pulmonary lesions caused by intestinal I and R process.