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. 2020 Winter;19(1):57-67.
doi: 10.22037/ijpr.2019.15546.13167.

Early Graft Function in Deceased Donor Renal Recipients: Role of N-Acetylcysteine

Atieh Modarresi  1   2 , Mohsen Nafar  3 , Zahra Sahraei  2   4 , Jamshid Salamzadeh  2 , Shadi Ziaie  2
Affiliations

Early Graft Function in Deceased Donor Renal Recipients: Role of N-Acetylcysteine

Atieh Modarresi et al. Iran J Pharm Res. 2020 Winter.

Abstract

Reduced graft function (RGF) in donor renal transplant recipients is caused by oxidative damage due to extensive ischemia-reperfusion (I/R) injury during transplantation. Neutrophil gelatinase-associated lipocalin (NGAL) is a promising biomarker to detect tubular injury early after renal transplantation. N-acetylcysteine (NAC) is a potent antioxidant that can reduce I/R injury by improving oxidative damage. The aim of the present study is to assess the efficacy of NAC in improving graft function and reducing renal tubular injury in deceased donor renal transplant recipients. A double-blind, randomized clinical trial was conducted on 50 deceased donor renal transplant recipients. The patients were randomized into two groups, receiving either 600 mg NAC twice daily, or placebo (days 0 to 5). Results were assessed based on the rate of RGF, levels of plasma NGAL (p-NGAL) and the estimated glomerular filtration rate (eGFR). The rate of RGF was significantly lower in the patients receiving NAC vs. placebo (21.4% vs. 50%). The measurement of p-NGAL levels showed that the patients in the NAC group had significantly greater reduction of p-NGAL by both days 1 and 5 post-transplantation than those in the placebo group. A near steady-state eGFR level was reached by week 1 in the NAC group, however, the improvement of eGFR was significantly slower in the placebo group and a near steady-state was only achieved by week 4. NAC has promising potential in reducing tubular injury and improving graft function, evidenced by significant reduction in the rate of RGF and levels of p-NGAL.

Keywords: Acetylcysteine; Glomerular Filtration Rate; Kidney Transplantation; Lipocalin-2; Reperfusion Injury; Transplants.

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Figures

Figure 1
Figure 1
Randomization, treatment and follow-up procedures
Figure 2
Figure 2
Early graft function. IGF, immediate graft function; SGF, slow graft function; DGF, delayed graft function
Figure 3
Figure 3
Plasma NGAL level during study intervention
Figure 4.
Figure 4.
Estimated glomerular filtration rate during the 12-week follow-up
See this image and copyright information in PMC

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