Early Graft Function in Deceased Donor Renal Recipients:Role of N-Acetylcysteine

Reduced graft function (rgf) in donor renal transplant recipients is caused by oxidativedamage due to extensive ischemia-reperfusion (i/r) injury during transplantation. neutrophilgelatinase-associated lipocalin (ngal) is a promising biomarker to detect tubular injury earlyafter renal transplantation. n-acetylcysteine (nac) is a potent antioxidant that can reduce i/rinjury by improving oxidative damage. the aim of the present study is to assess the efficacyof nac in improving graft function and reducing renal tubular injury in deceased donor renaltransplant recipients. a double-blind, randomized clinical trial was conducted on 50 deceaseddonor renal transplant recipients. the patients were randomized into two groups, receiving either600 mg nac twice daily, or placebo (days 0 to 5). results were assessed based on the rate ofrgf, levels of plasma ngal (p-ngal) and the estimated glomerular filtration rate (egfr). therate of rgf was significantly lower in the patients receiving nac vs. placebo (21.4% vs. 50%).the measurement of p-ngal levels showed that the patients in the nac group had significantlygreater reduction of p-ngal by both days 1 and 5 post-transplantation than those in the placebogroup. a near steady-state egfr level was reached by week 1 in the nac group, however, theimprovement of egfr was significantly slower in the placebo group and a near steady-state wasonly achieved by week 4. nac has promising potential in reducing tubular injury and improvinggraft function, evidenced by significant reduction in the rate of rgf and levels of p-ngal.