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The effect of ischemia/reperfusion on the kidney graft

Menke, Juliaa; Sollinger, Daniela; Schamberger, Beatea; Heemann, Uweb; Lutz, Jensa

Current Opinion in Organ Transplantation: August 2014 - Volume 19 - Issue 4 - p 395–400
doi: 10.1097/MOT.0000000000000090

Purpose of review Ischemia/reperfusion injury is an unavoidable companion after kidney transplantation and influences short-term as well as long-term graft outcome. Clinically ischemia/reperfusion injury is associated with delayed graft function, graft rejection, and chronic graft dysfunction. Ischemia/reperfusion affects many regulatory systems at the cellular level as well as in the renal tissue that eventually result in a distinct inflammatory reaction of the kidney graft.

Recent findings Underlying factors include energy metabolism, cellular changes of the mitochondria and cellular membranes, initiation of different forms of cell death-like apoptosis and necrosis together with a recently discovered mixed form termed necroptosis. Chemokines and cytokines together with other factors promote the inflammatory response leading to activation of the innate immune system as well as the adaptive immune system. If the inflammatory reaction continues within the graft tissue, a progressive interstitial fibrosis develops that impacts long-term graft outcome.

Summary It is of particular importance in kidney transplantation to understand the underlying mechanisms and effects of ischemia/reperfusion on the graft as this knowledge also opens strategies to prevent or treat ischemia/reperfusion injury after transplantation in order to improve graft outcome.

aSection of Nephrology, I. Department of Medicine, Johannes-Gutenberg University Mainz, Mainz

bDepartment of Nephrology, University Hospital, Technical University Munich, Munich, Germany

Correspondence to Prof Dr med Jens Lutz, Section of Nephrology, I. Department of Medicine, Johannes-Gutenberg University, Langenbeckstr. 1, 55131 Mainz, Germany. Tel: +6131 17 2462; fax: +6131 17 8471; e-mail:

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