Strategies to optimize kidney recovery and preservation in transplantation: specific aspects in pediatric transplantation

Abstract

In renal transplantation, live donor kidney grafts are associated with optimum success rates due to the shorter period of ischemia during the surgical procedure. The current shortage of donor organs for adult patients has caused a shift towards deceased donors, often with co-morbidity factors, whose organs are more sensitive to ischemia-reperfusion injury, which is unavoidable during transplantation. Donor management is pivotal to kidney graft survival through the control of the ischemiareperfusion sequence, which is known to stimulate numerous deleterious or regenerative pathways. Although the key role of endothelial cells has been established, the complexity of the injury, associated with stimulation of different cell signaling pathways, such as unfolded protein response and cell death, prevents the definition of a unique therapeutic target. Preclinical transplant models in large animals are necessary to establish relationships and kinetics and have already contributed to the improvement of organ preservation. Therapeutic strategies using mesenchymal stem cells to induce allograft tolerance are promising advances in the treatment of the pediatric recipient in terms of reducing/withdrawing immunosuppressive therapy. In this review we focus on the different donor management strategies in kidney graft conditioning and on graft preservation consequences by highlighting the role of endothelial cells. We also propose strategies for preventing ischemia-reperfusion, such as cell therapy.

Djelovanje hladne ishemije tijekom transplantacije bubrega

“…UW otopina ima i nekoliko nedostataka kao što su velika osmolarnost, kratki vijek aktivnosti dodanog glutationa te visoka cijena. Poznavajući mehanizme oštećenja koji nastaju tijekom hladne ishemije UW otopina ipak ne pruža dovoljnu zaštitu tkivu bubrega 41,42 . Najbliža po učinkovitosti UW otopini je Histidin--Triptofan-Ketoglutarat otopina (HTK), razvijena dodavanjem snažnog puferskog sustava, sastavljenog od histidina u kombinaciji s dva supstrata.…”

Novel preservation methods to increase the quality of older kidneys

“…Older kidneys have a stronger allogenic effect, provoking a higher rejection rate [11 & ]. Innovative research has been done using stem cells to modulate the immune response in the recipient by creating a immunogenic tolerance toward the graft [50]. In addition to silencing of the immune response, stem cells have the ability to stimulate regeneration.…”

Tannic Acid Improves Renal Function Recovery after Renal Warm Ischemia–Reperfusion in a Rat Model

“…4 • C) during transport (from 2 to 36 h). IRI induces several pathways, such as inflammation, cellular death by necrosis or apoptosis and oxidative stress, particularly during the reperfusion stage [1,2]. Oxidative stress is an imbalance between reactive oxygen species (ROS) production and elimination by antioxidant systems.…”