Ischemia and reperfusion injury in renal transplantation: hemodynamic and immunological paradigms

Abstract

Ischemia and reperfusion injury is an inevitable event in renal transplantation. The most important consequences are delayed graft function, longer length of stay, higher hospital costs, high risk of acute rejection, and negative impact of long-term follow-up. Currently, many factors are involved in their pathophysiology and could be classified into two different paradigms for education purposes: hemodynamic and immune. The hemodynamic paradigm is described as the reduction of oxygen delivery due to blood flow interruption, involving many hormone systems, and oxygen-free radicals produced after reperfusion. The immune paradigm has been recently described and involves immune system cells, especially T cells, with a central role in this injury. According to these concepts, new strategies to prevent ischemia and reperfusion injury have been studied, particularly the more physiological forms of storing the kidney, such as the pump machine and the use of antilymphocyte antibody therapy before reperfusion. Pump machine perfusion reduces delayed graft function prevalence and length of stay at hospital, and increases long-term graft survival. The use of antilymphocyte antibody therapy before reperfusion, such as Thymoglobulin™, can reduce the prevalence of delayed graft function and chronic graft dysfunction.

FcγRIIa defunctioning polymorphism in paediatric patients with renal allograft

“…With the recognition of risk factors and the development of immunosuppressive therapy, these rates have been reduced to less than 10%-15% in most centres. In most clinical studies, AR is viewed as a risk factor for chronic rejection (CR) [ 19 , 20 ]. As the frequency and severity of AR increase, CR and graft loss also increase.…”

The effect of insulin-loaded linear poly(ethylene glycol)-brush-like poly(L-lysine) block copolymer on renal ischemia/reperfusion-induced lung injury through downregulating hypoxia-inducible factor

“…27 RI/RI occurs in approximately 5% of hospitalized patients and up to 30% of patients in intensive care units. 28,29 Pretreatment with insulin can reduce the injury for hospitalized patients. At present, insulin preconditioning has been used clinically in many hospitals to reduce ischemia reperfusion injury.…”

Relaxin Positively Influences Ischemia—Reperfusion Injury in Solid Organ Transplantation: A Comprehensive Review

“…One possible solution for this problem is to extend the potential donor pool by using extended criteria donors (ECD) [10]. As these donors are older and have more comorbidities, organs are more prone to ischemia reperfusion injury (IRI) resulting in higher rates of delayed graft function, acute and chronic graft rejection and worse overall SOT outcomes [11][12][13][14][15]. There is a huge scientific effort to find ways in reducing IRI in order to increase the number of suitable organs procured from ECD.…”