Protection of the Endothelium and Endothelial Glycocalyx by Albumin and Sulodexide in Porcine Model of Kidney Transplant.

Objectives: Kidney transplant is a life-saving procedure for patients with end-stage renal disease. Success of kidney transplant is highly dependent on maintaining the integrity of the endothelium and its protective layer, the endothelial glycocalyx. Ischemia-reperfusion injury, a common challenge in kidney transplant, can disrupt the endothelial glycocalyx, leading to various post-transplant complications. We investigated the effects of albumin and sulodexide, 2 therapeutic agents, for protection of the endothelium and endothelial glycocalyx in a porcine model of kidney transplant.

Materials and methods: Fourteen female piglets were prepared for kidney transplant simulation and randomly divided into 3 groups: a control group, an albumin-treated group, and a sulodexide-treated group. Various physiological parameters were monitored, and samples for serum and urine were collected at baseline and at multiple time points after reperfusion. Integrity of the endothelial glycocalyx was assessed from serum syndecan-1 levels and urinary glycosaminoglycan concentrations. Histology of the renal cortex allowed evaluation of tissue changes following the intervention.

Results: Statistically significant differences were observed in the sulodexide-treated group, where serum syndecan-1 levels were lower versus the control group at 5 minutes after reperfusion (P = .046), indicating a potential reduction in endothelial glycocalyx damage. Similarly, in the albumin-treated group, urinary glycosaminoglycan levels were significantly lower versus the control group at 5 minutes after reperfusion (P = .041), which may suggest a protective effect on the endothelial glycocalyx. However, these findings are preliminary, and no other significant differences were detected between the treatment groups and the control group at later time points. Histology of the renal cortex revealed that the changes were generally minor across all groups.

Conclusions: We suggest that albumin and sulodexide may offer beneficial effects in preserving endothelial function during kidney transplant. The potential for these agents to enhance graft survival and improve kidney transplant outcomes warrants further investigation.