Effect of synthetic protease inhibitor gabexate mesilate on the attenuation of ischemia/reperfusion injury in canine kidney autotransplantation

Kidneys from non-heart-beating donors are associated with delayed graft function and a high rejection rate due to the long period of warm ischemia. Gabexate mesilate (GM), a synthetic serine protease inhibitor, has been shown to improve organ function by suppressing cytokine activity and neutrophil function after ischemia/reperfusion. In this study, we evaluated the effect of GM on renal function after warm ischemia in a canine kidney autotransplantation model. After 60 minutes of warm ischemia, the left kidney was transplanted into the iliac fossa, and the right kidney was removed. The control group (n = 7) and GM group (n = 7) were evaluated for serum creatinine and blood urea nitrogen (BUN) concentrations, renal tissue blood flow, resistive index, pulsatility index, interleukin (IL)-1β and tumor necrosis factor (TNF)-α mRNA expression levels in peripheral blood mononuclear cells, apoptotic index, CD10 immunolabeling as an indicator of brush border injury, and standard histopathology. Compared with controls, administration of GM resulted in lower serum creatinine concentrations (11.3 ± 2.4 vs 5.2 ± 3.3 mg/dL at 72 hours; P =. 04) and BUN concentrations (188 ± 26 mg/dL vs 98 ± 41 mg/dL at 72 hours; P =. 04), as well as better tissue blood flow, improvement of brush border injury and apoptotic index (each P <. 05). The expression of IL-1β and TNF-α mRNA did not change after administration of GM. The present study shows that GM protected renal function after warm ischemia/reperfusion by inhibition of serine proteases, maintenance of tissue blood flow, and amelioration of tubular apoptosis.