Perioperative renal protective strategies in kidney transplantation

The outcome of kidney transplantation has improved substantially at the end of last century due to improved medication against rejection. Nevertheless part of the kidney function will be lost during the process of donation and transplantation. A number of harmful processes will inevitably occur affecting short and long term quality of the graft. The perioperative period of the transplant recipient, however, could be an attractive window of opportunity to reduce this injury. In this thesis I have looked for different strategies applied during the transplantation with the aim to improve the outcome of the transplanted kidney and/or reduce postoperative complications. Pharmacological conditioning with the use of the EPO derivate ara290 and the volatile anesthetic agent sevoflurane are possibly associated with improved short and long term outcome. Remote ischemic conditioning by the use of a tourniquet around the thigh in recipients of kidneys from deceased donors, on the other hand, had no effect on early function of the transplanted kidney. Additionally this thesis shows that most transplant recipients preoperatively show an increased clotting tendency. Therefore the use of intraoperative anticoagulant therapy during the transplantation might my beneficial. Next to this a sufficient amount of fluid administered during the transplantation reduces the likelihood of delayed graft function.
A combination of several of these strategies ultimately could lead to a renal protective protocol applicable during kidney transplantation facilitating short and long term outcome after kidney transplantation (enhanced recovery after transplantation, ERAT)