The Role of Endothelial Glycocalyx in Kidney Transplantation

Study Overview
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Brief Summary
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The goal of this observational study is detailed examination of endothelial glycocalyx in kidney transplantation. Researchers will evaluate markers of degradation of EG in blood and urine; and also perform direct visualisation of EG with sidestream dark field imaging (SDF) in both donors and recipients of kidney transplantation. The aim is to summarize the current knowledge and to point out the importance of EG in kidney transplantation.

Detailed Description
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The endothelial glycocalyx (EG) is a thin layer on the surface of the endothelium that plays an important role for microcirculation and tissue metabolism. The role of EG is diverse - it acts as a protection of the endothelium against shear stress which is mediated on the intracellular structures of endothelial cells, allows the interaction of blood elements and endothelium, prevents the formation of uncontrolled thrombosis and excessive oxidative stress by free radicals. EG dysfunction can occur with partial or complete loss of its components, resulting in impaired vascular regulation and increased vascular permeability. Disruption or dysfunction of EG has been associated with disease states such as diabetes, chronic kidney disease, inflammatory conditions, sepsis, hypernatraemia, hypervolaemia and ischaemia/reperfusion injury. Enzymes such as hyaluronidase and metalloproteinases can degrade the components of EG. Damage to EG leads to the release of breakdown products into the bloodstream which can be detected. There are also direct methods of visualization of EG. Thanks to advances in the study of EG in kidney transplantation a comprehensive relationship in this field and specific clinical aspects can be assessed. In the future exploring potential therapeutic options to protect EG may have implications for better graft function and survival.

Official Title
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The Role of Endothelial Glycocalyx in Kidney Transplantation

Conditions
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Kidney Transplantation

Intervention / Treatment
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* Procedure: Kidney Transplantation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients undergoing kidney transplantation Exclusion Criteria: Patients who don't sign the informed consent
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Donors<br> | |
| Recipients<br> | Procedure: Kidney Transplantation<br>* Kidney transplantation as the best option for patients with end-stage kidney disease.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Examination of Endothelial Glycocalyx in Donors | Correlation between the status of EG in donors and kidney function after kidney transplantation ( | 1 year | 
| Examination of Endothelial Glycocalyx in Recipients | Description of microcirculation directly from the kidney's surface in 1 and 20 minutes after reperfusion (with Side stream darkfield imaging and Perfused boundary region) | 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Endothelial Glycocalyx under different settings | Description of EG in living donors, donors after brain death, donors after circulatory death (measurements of degradation products od EG - mainly syndecan-1 in blood and urine) | 1 year | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Endothelial, Glycocalyx