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ORIGINAL ARTICLES  CARDIAC SECTION 

The Journal of Cardiovascular Surgery 2001 December;42(6):759-68

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Cytokine induction by LVAD in the canine kidney

Yamagishi T., Oshima K., Hasegawa Y., Mohara J., Kanda T., Ishikawa S., Morishita Y.

From the Second Department of Surgery, *Department of Laboratory Medicine, Gunma University School of Medicine, Maebashi, Japan


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Background. The out­come of ­left ven­tric­u­lar ­assist ­device (­LVAD) sup­port is report­ed to be asso­ciat­ed ­with pro­in­flam­ma­to­ry cyto­kines. We inves­ti­gat­ed ­the ­effect of ­LVAD sup­port on ­renal func­tion ­and ­the resul­tant cyto­kine induc­tion.
Methods. A pros­pec­tive experi­men­tal ­study ­was per­formed ­using 15 mon­grel ­dogs weigh­ing 14 to 36 kg. ­LVAD ­was intro­duced in ­nine ­dogs (­LVAD ­group) ­and ­the remain­ing ­six ­dogs ­were man­aged with­out ­LVAD sup­port (con­trol ­group). All ani­mals ­were ­observed ­for ­six ­hours ­after tho­rac­o­tomy. Renal region­al ­blood ­flow ­was meas­ured, ­and albu­min-crea­ti­nine ­ratio (ACR) ­and N-ace­tyl-β-D-glu­co­sea­min­i­dase ­index (NAGI) ­were eval­u­at­ed as param­e­ters of glo­mer­u­lar ­and tubu­lar func­tion, respec­tive­ly. Tumor necro­sis fac­tor α (­TNF-α) con­cen­tra­tions in ­the ­blood ­and homog­en­ate of ­renal tis­sues ­were meas­ured ­and immu­no­his­to­log­i­cal exam­ina­tion of ­renal tis­sues ­was con­duct­ed by ­means of anti­-nu­clear fac­tor κB (NF-κB), ­TNF-α ­and inter­leu­kin 1β (IL- 1β) anti­bod­ies.
Results. In ­the ­LVAD ­group, ­the ­renal cor­tex-medul­lar ­blood ­flow ­ratio sig­nif­i­cant­ly (p<0.05) ­decreased, ­and ­ACR ­was sig­nif­i­cant­ly (p<0.05) high­er ­than in ­the con­trol ­group, indi­cat­ing glo­mer­u­lar insuf­fi­cien­cy. There ­were no sig­nif­i­cant dif­fer­enc­es in ­NAGI ­and ­TNF-α lev­els in ­the ­blood ­and ­renal tis­sues ­between ­the ­two ­groups. Immunohistological ­examina­tion of ­renal tis­sues dem­on­strat­ed an accu­mu­la­tion of NF-κB, ­TNF-α, ­and IL-1β in ­the ­LVAD ­group.
Conclusions. An ­LVAD ­alters ­renal region­al ­blood ­flow ­and induc­es a ­small ­amount of cyto­kines. We spec­u­late ­that if an ­LVAD is intro­duced dur­ing system­ic inflam­ma­to­ry ­response syn­drome, ­the ­LVAD ­will ­induce a “sec­ond ­attack” result­ing in mul­ti­or­gan fail­ure. For suc­cess­ful ­LVAD sup­port, ­the appro­pri­ate selec­tion of ­time peri­ods is essen­tial.

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