Effect of multimodal analgesia on immunological function after renal transplantation

doi:10.3969/j.issn.2095-4344.2014.36.023

Abstract

Abstract:

BACKGROUND: Multimodal analgesia provides sufficient analgesia in renal recipients and appears to be associated with the recovery of renal function after transplantation.
OBJECTIVE: To investigate the effect of multimodal analgesia with dezocine on postoperative immunity after renal transplantation, and discuss the appropriate analgesic drugs and methods for patients with renal transplantation.
METHODS: Forty patients undergoing renal transplantation were randomly divided into two groups. They all received general anesthesia combined with epidural blockage. Control group received intramuscular injection of analgesic drugs when needed, while dezocine group received multimodal analgesia: preemptive anaIgesia with dezocine + patient-controlled epidural analgesia. The heart rate, mean arterial pressure, and saturation of blood oxygen were detected before anesthesia, 12, 24, 48 hours after transplantation. T lymphocyte subsets, interleukin-2, interleukin-6 and interleukin-10 levels in venous blood were measured before anesthesia, 12, 24, 48 hours after transplantation.
RESULTS AND CONCLUSION: Compared with before anesthesia, the CD4⁺, CD8⁺ cell subset counts, CD4⁺/CD8⁺ ratio, the levels of interleukin-2 and interleukin-6 were decreased significantly (P < 0.05), and the levels of interleukin were significantly increased after transplantation in the control group (P < 0.05). The postoperative CD4⁺ cell subset counts, the levels of interleukin-2 and interleukin-6 were significantly lower at 12 hours after transplantation than that before anesthesia (P < 0.05), then recovered to normal levels at 24 hours in dezocine group. The postoperative CD8⁺ cell subset counts, CD8⁺ and CD4⁺/CD8⁺ ratio were not changed before and after transplantation in the dezocine group. The levels of interleukin-10 in the dezocine group were significantly increased at 48 hours after transplantation compared with before anesthesia (P < 0.05), which was still lower than that in control group (P < 0.05). Multimodal analgesia with dezocine can effectively protect the immune system, promote short-term turnover of renal function, and prolong graft survival for patients with renal transplantation.

中国组织工程研究杂志出版内容重点：肾移植；肝移植；移植；心脏移植；组织移植；皮肤移植；皮瓣移植；血管移植；器官移植；组织工程

全文链接：

Key words: kidney transplantation, analgesics, immunity, cytokines

CLC Number:

R318

Li Hong, Luo Yuan-guo, Zhang Xu, Zeng Jun, Wang Dong, Yuan Zhen-yu, Yuan Feng, Xu Wei-guo, Chen Jie-jing. Effect of multimodal analgesia on immunological function after renal transplantation[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(36): 5874-5878.

Figures/Tables 1

References

[1] 徐迎阳,尚红.肾移植术后硬膜外病人自控镇痛对血浆内皮素及肾功能的影响[J].中华麻醉学杂志,2002,22(1):21-23.
[2] 罗远国,李洪,杨天德.肾移植手术与多模式镇痛[J].重庆医学, 2010,39(19):2614-2615,2611.
[3] 曾军,罗远国,李洪,等.不同镇痛方式对肾移植患者术后镇痛效果及肾功能的影响[J].重庆医学,2011,40(32):3249-3251.
[4] Shearer GM, Clerici M. In vitro analysis of cell-mediated immunity: clinical relevance. Clin Chem. 1994;40(11 Pt 2): 2162-2165.
[5] Umeshappa CS, Nanjundappa RH, Xie Y,et al. Differential requirements of CD4(+) T-cell signals for effector cytotoxic T-lymphocyte (CTL) priming and functional memory CTL development at higher CD8(+) T-cell precursor frequency. Immunology. 2013;138(4):298-306.
[6] Nakanishi Y, Lu B, Gerard C,et al.CD8(+) T lymphocyte mobilization to virus-infected tissue requires CD4(+) T-cell help.Nature. 2009;462(7272):510-513.
[7] Nakanishi Y, Lu B, Gerard C,et al.CD8(+) T lymphocyte mobilization to virus-infected tissue requires CD4(+) T-cell help.Nature. 2009;462(7272):510-513.
[8] Koshiba T, Li Y, Takemura M,et al. Clinical, immunological, and pathological aspects of operational tolerance after pediatric living-donor liver transplantation.Transpl Immunol. 2007;17(2):94-97.
[9] Kulhankova K, Rouse T, Nasr ME,et al. Dendritic cells control CD4+CD25+ Treg cell suppressor function in vitro through juxtacrine delivery of IL-2.PLoS One. 2012;7(9):e43609.
[10] Wang G, Khattar M, Guo Z,et al. IL-2-deprivation and TGF-beta are two non-redundant suppressor mechanisms of CD4+CD25+ regulatory T cell which jointly restrain CD4+CD25- cell activation. Immunol Lett. 2010;132(1-2):61-68.
[11] Dasgupta A, Mahapatra M, Saxena R. Flow cytometric immunophenotyping of regulatory T cells in chronic lymphocytic leukemia: comparative assessment of various markers and use of novel antibody panel with CD127 as alternative to transcription factor FoxP3.Leuk Lymphoma. 2013;54(4):778-789.
[12] Klein S, Kretz CC, Krammer PH,et al. CD127(low/-) and FoxP3(+) expression levels characterize different regulatory T-cell populations in human peripheral blood. J Invest Dermatol. 2010;130(2):492-499.
[13] Simonetta F, Chiali A, Cordier C,et al. Increased CD127 expression on activated FOXP3+CD4+ regulatory T cells.Eur J Immunol. 2010;40(9):2528-2538.
[14] Hansen EG, Duedahl TH, Rømsing J,et al. Intra-operative remifentanil might influence pain levels in the immediate post-operative period after major abdominal surgery.Acta Anaesthesiol Scand. 2005;49(10):1464-1470.
[15] Ducloux D, Courivaud C, Bamoulid J,et al. Prolonged CD4 T cell lymphopenia increases morbidity and mortality after renal transplantation.J Am Soc Nephrol. 2010;21(5):868-875.
[16] Biki B, Mascha E, Moriarty DC,et al. Anesthetic technique for radical prostatectomy surgery affects cancer recurrence: a retrospective analysis.Anesthesiology. 2008;109(2):180-187.
[17] Welden B, Gates G, Mallari R, et al.Effects of anesthetics and analgesics on natural killer cell activity.AANA J. 2009;77(4): 287-292.
[18] Fishman JA. Infection in solid-organ transplant recipients. N Engl J Med. 2007;357(25):2601-2614.
[19] 熊海云,张雷,王立明,等.肾移植术后早期严重肺部感染患者外周血CD4+T淋巴细胞计数的临床意义[J].中华器官移植杂志,2009, 30(6):334-337.
[20] Ni Choileain N, Redmond HP.Cell response to surgery.Arch Surg. 2006;141(11):1132-1140.
[21] Atkins MB. Interleukin-2: clinical applications.Semin Oncol. 2002;29(3 Suppl 7):12-17.
[22] 李洪霞,张进川,赵亚力,等.白细胞介素-10对急性肺损伤炎症/抗炎介质表达的影响[J].中国危重病急救医学,2005,17(6): 338-341.
[23] 田亚平,谷峰,郭广宏.肾移植术后血清细胞因子及生化指标的动态变化研究[J].中华检验医学杂志,2005,28(8):836-839.
[24] 宫玉波,陆晓和,周瑾,等.γ-干扰素、白细胞介素4与CD25在角膜移植免疫排斥反应中的作用[J].中国组织工程研究与临床康复, 2008,12(5):861-867.
[25] 谢松业,丁星,赵超,等.肾同种移植排斥患者血清可溶性TNF相关凋亡诱导配体及多种细胞因子水平变化的临床意义[J].实用医学杂志,2005,21(17):1908-1910.
[26] Armaka M, Apostolaki M, Jacques P,et al. Mesenchymal cell targeting by TNF as a common pathogenic principle in chronic inflammatory joint and intestinal diseases.J Exp Med. 2008; 205(2):331-337.
[27] Karczewski J, Karczewski M, Glyda M, et al. Role of TH1/TH2 cytokines in kidney allograft rejection.Transplant Proc. 2008; 40(10):3390-3392.
[28] Amirzargar A, Lessanpezeshki M, Fathi A,et al. TH1/TH2 cytokine analysis in Iranian renal transplant recipients. Transplant Proc. 2005;37(7):2985-2987.
[29] Beilin B, Shavit Y, Trabekin E,et al.The effects of postoperative pain management on immune response to surgery.Anesth Analg. 2003;97(3):822-827.
[30] 吴秀玲,魏兆锦,宋斌.术后两种镇痛方式对炎性细胞因子的影响[J].临床麻醉学杂志,2011,27(5):480-482.
[31] Biki B, Mascha E, Moriarty DC,et al. Anesthetic technique for radical prostatectomy surgery affects cancer recurrence: a retrospective analysis.Anesthesiology. 2008;109(2):180-187.
[32] Nose K, Oki T, Banno E,et al. Cytomegalovirus infection after prophylactic valganciclovir therapy post-kidney transplantation: case reports.Transplant Proc. 2012;44(1): 296-298.
[33] Goto N, Oka S. Pneumocystis jirovecii pneumonia in kidney transplantation.Transpl Infect Dis. 2011;13(6):551-558.