Laparoskopische Lebendspender-Nephrektomie und Autotransplantation nach perivaskulär injiziertem Papaverin - Experimentelle Studie am Schwein

LAPAROSCOPIC LIVE DONOR NEPHRECTOMY AND AUTOTRANSPLANTATION AFTER
PERIVASCULAR PAPAVERINE APPLICATION - EXPERIMENTAL STUDY IN PIGS
The aim of this study is to evaluate whether renal function and
blood perfusion can be enhanced by periarterial application of
papaverine during laparoscopic donor nephrectomy in pigs. The study
is subdivided in two parts. In part one, intraoperative urine
output and creatinine-clearance are measured to investigate the
influence of perivascular papaverine on renal function during the
laparoscopic procedure. In part two of the study, blood perfusion
of both kidneys during laparoscopic left donor nephrectomy is
determined using fluorescent-labeled microspheres to analyse the
vasodilatative effect of papaverine. In a subgroup of animals the
donor nephrectomy is followed by autotransplantation and initial
renal function is measured for a period of 24 hours after
papaverine administration and laparoscopic nephrectomy.
Histopathological examination of random samples is performed to
evaluate structural damage following nephrectomy and
autotransplantation. This study is carried out to refer to the
actual clinical situation. After perivascular administration of
papaverine an increase of renal function during laparoscopic
nephrectomy can be achieved. Compared to controls urine output and
creatinine-clearance is significantly improved after local
papaverine application. In part two of the study measurement of
renal blood flow shows enhanced renal perfusion after application
of the vasodilatator in the treatment group. After
autotransplantation the papaverine group exhibits an improved
initial renal function. Enhanced creatinine-clearance has to be
varified by further experiments. Histopathological signs of tissue
damages of various extend can be found in all samples. The results
presented are interpreted as follows: local periarterial
application of papaverine increases renal blood flow during
laparoscopic donor nephrectomy. Therefore renal function seems to
be augmented. In controls decreased organ perfusion seems to lead
to impaired renal function. In consequence the presented study
demonstrates a significant better graft function in the treatment
group. This method might have the potential to significantly
improve graft quality after laparoscopic live donor nephrectomy in
human patients.