Background. Diabetes is a risk factor for delayed graft function in kidney transplantation, and hyperglycemia increases ischemia\r\nreperfusion injury in animal models. Methods. To explore the role of perioperative hyperglycemia in ischemia reperfusion injury,\r\nwe conducted a prospective study of 40 patients undergoing living donor renal transplantation. Blood glucose levels were\r\nmonitored intraoperatively, and serum samples were obtained at the time anesthesia was induced and one hour after allograft\r\nreperfusion. The percentage change in neutrophil gelatinase-associated lipocalin (NGAL), a protein whose expression is increased\r\nwith renal ischemia, was then used to determine the extent of injury. Results. In a multivariate model including recipient, donor,\r\nand transplant factors, recipient blood glucose >160 mg/dL at the time of allograft reperfusion (�Ÿ 0.19, P-value < 0.01), warm\r\nischemia time >30 minutes (�Ÿ 0.11, P-value 0.13), and recipient age (�Ÿ 0.05, P-value 0.05) were associated with percentage change\r\nin NGAL. These same predictors were associated with the percentage change in creatinine on postoperative day 2. Conclusions.\r\nHyperglycemia is associated with increased ischemic injury in renal transplantation. Both creatinine and NGAL, a marker of\r\nischemic injury and renal function, fall less rapidly in patients with elevated blood glucose.
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