Ischemia-reperfusion injury (IRI) is inevitable during transplantation. Attempts to reduce IRI have mainly focused on ways to improve hypothermic organ preservation and reduce the nephrotoxic effects of calcineurin inhibitors. Recently, it has been shown that short, repeated sequences of intermittent ischemia and reperfusion after a prolonged ischemic episode, so-called ischemic postconditioning (IPoC), reduce myocardial infarct size by approximately 40% in animal models and in humans. The principle of IPoC could be applied to every organ after ischemic injury, including kidney transplants. In fact, IPoC has demonstrated its clinical potential by reducing IRI in different organs in several animal models. In this review, we provide an overview of animal experiments on renal IRI and IPoC, demonstrating benefits with respect to organ damage and kidney function. We propose potential mechanisms by which IPoC protects against IRI. However, thus far, no human trials investigating IPoC in transplantation have been performed. Such clinical studies are needed to establish whether a simple procedure such as IPoC can improve the outcomes of human organ transplantation.
1 Division of Transplant Surgery, Department of Surgery, Erasmus MC-University Medical Center, Rotterdam, The Netherlands.
2 Heart Transplant Unit, Department of Cardiology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands.
3 Division of Nephrology and Renal Transplantation, Department of Internal Medicine, Erasmus MC-University Medical Center, Rotterdam, The Netherlands.
4 Address correspondence to: Frank J.M.F. Dor, M.D., Ph.D., Division of Transplant Surgery, Department of Surgery, Erasmus MC-University Medical Center, Room H-903, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
The authors declare no funding or conflicts of interest.
Received 12 October 2012. Revision requested 7 November 2012.
Accepted 5 December 2012.