Microdialysis monitoring for evaluation of the influence exertedby pneumoperitoneum on the kidney: an experimental study

• BackgroundLaparoscopic donor nephrectomy hasbecome the first choice for living donor kidney transplantation,offering advantages over open donor nephrectomy.This study aimed to evaluate kidney tissue metabolismduring and after pneumoperitoneum using a microdialysistechnique.MethodsEight pigs underwent laparotomy and implantationof two microdialysis catheters: one in the cortex andone in the medulla of the left kidney. After laparotomy, theabdominal wall was closed, and pneumoperitoneum wasinduced with a constant standard pressure of 16 to 18mmHg for 4 h, followed by rapid desufflation. In microdialysissamples collected from intrarenal catheters,markers of ischemia (glucose, lactate, pyruvate, and lactate–pyruvate ratio) and the marker of cell membraneinjury (glycerol) were monitored.ResultsThere were no changes in glucose, lactate, orpyruvate level before, during, or after pneumoperitoneum,either in the cortex or in the medulla. Additionally, thecalculated lactate–pyruvate ratio did not show signs ofischemia during or after pneumoperitoneum. However,with regard to the marker of cell injury, glycerol increasedin the medulla after decompression from 22.57 ± 3.76 to35.67 ± 5.43 mmol/l (p < 0.01). This release of glycerol inthe medulla was significantly higher than in the cortex(area under the curve [AUC], 22.18 ± 4.87 vs34.79 ± 7.88 mmol/l;p < 0.01).ConclusionsThe pattern of metabolic changes monitoredin the kidney during and after pneumoperitoneum indicatessome kind of cell injury predominant in the medulla withoutany signs of kidney ischemia. This nonischemic injury couldbe related to hyperperfusion of the kidney after decompressionor injury to cells attributable to mechanical cellexpansion at the point of rapid decompression.

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Transplantation

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