Ischaemic and inflammatory injury in renal graft from brain death donation: an update review

Renal transplantation remains an important therapy in treating renal failure and can be considered to be a curative treatment. The demand for renal grafts outstrips supply available each year, making it increasingly important to look at improving the treatment of both renal grafts and recipients, an...

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Bibliographic Details
Published in:Journal of anesthesia 2016-04, Vol.30 (2), p.307-316
Main Authors: Fung, Anthony, Zhao, Hailin, Yang, Bob, Lian, Qingqian, Ma, Daqing
Format: Article
Language:English
Subjects:
Anesthesiology
Brain Death
Care and treatment
Complications and side effects
Critical Care Medicine
Emergency Medicine
Health aspects
Humans
Intensive
Invited Review Article
Ischemia
Kidney diseases
Kidney transplantation
Kidney Transplantation - methods
Medicine
Medicine & Public Health
Pain Medicine
Patient outcomes
Reperfusion Injury - physiopathology
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Summary:Renal transplantation remains an important therapy in treating renal failure and can be considered to be a curative treatment. The demand for renal grafts outstrips supply available each year, making it increasingly important to look at improving the treatment of both renal grafts and recipients, and thereby improving patient outcomes and increasing the pool of potential donor grafts. Important to this, however, is knowledge of the underlying mechanisms leading to damage to the graft and rejection from the recipient. This includes ischaemia and consequently the priming of the organ during storage for ischaemia reperfusion injury (IRI) on implantation and the importance of the innate immune system which can be activated via multiple pathways, often via TLR-4, and the consequent production of danger-associated molecular patterns. This makes the time period involving both explantation and storage an important therapeutic window for improving outcomes. Other windows explored include treatment of IRI and improvement in immunosuppressive therapy. The multiple windows of potential therapeutic input have spawned a large body of work exploring both the underlying mechanisms and also how to exploit these mechanisms to improve overall outcomes and to allow for more marginal organs to be used.
ISSN:0913-8668
1438-8359
DOI:10.1007/s00540-015-2120-y