The contribution of Na+/H+ exchange to postreperfusion injury and recoveryof transplanted kidney

Acute kidney injury soon after reperfusion seems to anticipate short- and l ong-term graft prognosis. Sodium-hydrogen exchanger (NHE) is involved in se veral steps of kidney graft function recovery, such as the restoration of i ntracellular pH, acute postreperfusion inflammation, and tubular epithelium repair and proliferation. We studied 20 first kidney transplantations by m easuring the erythrocyte NHE of both recipient and donor as well as recipie nt serum and urine indices of renal structural and functional integrity eve ry day since grafting. Heightened exchange activity in the donor-recipient couple resulted, which was associated to a prompt graft recovery together w ith a short stay for the donor in the intensive care unit, brief cold ische mia time, and a nonatherogenic lipoprotein profile for the recipient. Addit ional positive prognostic indices were time-zero diuresis and urinary excre tion rates of N-acetyl-beta-D-glucosaminidase (NAG) and albumin. Over the o ne-year follow-up period, a long post-transplantation hospital stay was ass ociated with a significantly increased risk of rejection, and the urinary a lanine-aminopeptide (AAP) excretion rate was confirmed as a useful criterio n for evaluating the clinical course of kidney graft. (C) 1999 Editions sci entifiques et medicales Elsevier SAS.