A MULTIVITAMIN INFUSION PREVENTS LIPID-PEROXIDATION AND IMPROVES TRANSPLANTATION PERFORMANCE

The objective of this study was to test the hypothesis that ischemia reperfusion damage in kidney transplantation is associated with lipid peroxidation and that inhibition of lipid peroxidation by antioxidants improves the function of the transplanted kidney. Lipid peroxidation was assessed by measuring the plasma malonaldehyde content (as thiobarbituric acid reaction product) with high-performance liquid chromatography. Kidney function was assessed by plasma creatinine and creatinine clearance. Thirty patients of an ongoing series were randomly selected into two groups, with 14 controls and 16 patients in the antioxidant therapy group. Therapy consisted of two ampoules of Omnibionta (which contains vitamins C, E, A and B complex) diluted in 500 ml physiological sodium chloride, which was infused intravenously prior to reperfusion onset. No significant differences existed for the age of the patients in the control (43.00 +/- 9.86 years) and the therapy group (41.56 +/- 14.14 years) nor in the kidney preservation time, which was 24.12 +/- 8.73 and 18.43 +/- 9.97 hours in the control and therapy group, respectively. The controls showed a transient increase of plasma lipid peroxides as measured by malonaldehyde with a peak one hour after onset of reperfusion. Compared to the baseline value of 0.74 +/- 0.26 (mean +/- SD) the one hour malonaldehyde value increased to 1.46 +/- 0.22 nmol/ml (P < 0.001). In the therapy group the plasma malonaldehyde level did not increase, but slightly decreased by about 20% compared to the baseline value. The difference of plasma malonaldehyde between the two groups one hour after reperfusion onset was highly significant (P > 0.0001). Compared to the control group, the therapy group had significantly lower creatinine values at the postoperative days 1, 2, 3 and 4 (P < 0.02, < 0.006, < 0.02 and < 0.02, respectively). Also, the creatinine clearance rates were significantly higher in the therapy group on days 1, 3 and 5 (P < 0.03, < 0.01 and < 0.007). From day 6 on, no further improvement of creatinine and creatinine clearance occurred in the therapy group and no significant difference existed toward controls. This study shows that antioxidative treatment by vitamins could be an important regimen in the reduction of reperfusion damage.