scholarly journals Review: Ischemia Reperfusion Injury—A Translational Perspective in Organ Transplantation

2020 ◽  
Vol 21 (22) ◽  
pp. 8549
Author(s):  
André Renaldo Fernández ◽  
Rodrigo Sánchez-Tarjuelo ◽  
Paolo Cravedi ◽  
Jordi Ochando ◽  
Marcos López-Hoyos
Keyword(s):  
Reperfusion Injury ◽  
Organ Transplantation ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Graft Loss ◽  
Surgical Techniques ◽  
Immunosuppressive Drugs ◽  
Donation Process ◽  
End Stage ◽  
Significant Injury

Thanks to the development of new, more potent and selective immunosuppressive drugs together with advances in surgical techniques, organ transplantation has emerged from an experimental surgery over fifty years ago to being the treatment of choice for many end-stage organ diseases, with over 139,000 organ transplants performed worldwide in 2019. Inherent to the transplantation procedure is the fact that the donor organ is subjected to blood flow cessation and ischemia during harvesting, which is followed by preservation and reperfusion of the organ once transplanted into the recipient. Consequently, ischemia/reperfusion induces a significant injury to the graft with activation of the immune response in the recipient and deleterious effect on the graft. The purpose of this review is to discuss and shed new light on the pathways involved in ischemia/reperfusion injury (IRI) that act at different stages during the donation process, surgery, and immediate post-transplant period. Here, we present strategies that combine various treatments targeted at different mechanistic pathways during several time points to prevent graft loss secondary to the inflammation caused by IRI.

Protocol for the pig liver ischemia/reperfusion injury

2020 ◽  
Author(s):  
Eric Felli ◽  
Mahdi Al-Taher ◽  
Emanuele Felli ◽  
Lorenzo Cinelli ◽  
Michele Diana
Keyword(s):  
Liver Transplantation ◽  
Reperfusion Injury ◽  
Liver Damage ◽  
Porcine Model ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Graft Loss ◽  
Vascular Complication ◽  
Liver Ischemia ◽  
Pig Liver

Abstract Liver ischemia/reperfusion injury (IRI) is a dreadful vascular complication, which leads to liver damage. It is often associated with graft loss in liver transplantation and with a higher morbidity and mortality. IRI can have different causes, such as inflow clumping during surgical procedures in hepatic resection, liver transplantation, trauma, as well as during the stenosis of the vasculature caused by cancer. Here, we show a detailed IRI protocol in a porcine model.

scholarly journals Liver transplantation without graft ischemia in humans

2020 ◽  
Author(s):  
Zhiyong Guo ◽  
Qiang Zhao ◽  
Shanzhou Huang ◽  
Changjun Huang ◽  
Jian Zhang ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Reperfusion Injury ◽  
Ischemia Reperfusion Injury ◽  
Absolute Risk ◽  
Ischemia Reperfusion ◽  
Surgical Techniques ◽  
Risk Difference ◽  
Clinical Trial Registry ◽  
Conventional Procedure ◽  
Normothermic Machine Perfusion

ABSTRACTBACKGROUNDIschemia-reperfusion injury is considered an inevitable event that compromises posttransplant outcomes. Numerous treatments have been proposed to reduce its impact. However, most of them have had limited success, as none of them can completely avoid graft ischemia.METHODSIschemia-free liver transplantation (IFLT) comprises surgical techniques to enable continuous oxygenated blood supply to brain-dead donor livers during procurement, preservation and implantation using normothermic machine perfusion technology. In this nonrandomized study, 38 donor livers were transplanted using IFLT and were compared to 130 livers procured and transplanted using a conventional procedure (CLT).RESULTSOne patient (2.6%) suffered early allograft dysfunction in the IFLT group, compared with 43.8% of patients in the CLT group (absolute risk difference, 41.2 percentage points; 95% confidence interval, −31.3, −51.1). The median (range) peak aspartate aminotransferase levels within the first week (336, 149-4112 vs. 1445, 149-25083 U/L, P<0.001), and the median (range) total bilirubin levels on day 7 (2.11, 0.68-12.47 vs. 5.11, 0.56-51.97 mg/dL, P<0.001) posttransplantation were much lower in the IFLT than in the CLT group. The IFLT recipients had less need for renal replacement therapy (2.6% vs. 16.9%, P=0.02), shorter median (range) intensive care unit stay (34, 12-235 vs. 43.5, 7-936 hours, P=0.003), and higher one-year recipient survival (97.4% vs. 84.6%, P=0.02) and graft survival (94.7% vs. 83.8%, P=0.04) rates than the CLT recipients. The extended criteria donor livers in IFLT yielded faster posttransplant recovery than the standard criteria donor livers in CLT.CONCLUSIONSIFLT provides a new approach to minimize ischemia-reperfusion injury and improve post-transplant outcomes.Clinical trial registryThis trial is registered with http://www.chictr.org.cn, number ChiCTR-OPN-17012090.

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

2020 ◽  
Vol 21 (2) ◽  
pp. 631 ◽  
Author(s):  
Lina Jakubauskiene ◽  
Matas Jakubauskas ◽  
Bettina Leber ◽  
Kestutis Strupas ◽  
Philipp Stiegler ◽  
...  
Keyword(s):  
Reperfusion Injury ◽  
Organ Transplantation ◽  
Ischemia Reperfusion Injury ◽  
Positive Impact ◽  
Ischemia Reperfusion ◽  
Graft Function ◽  
Solid Organ Transplantation ◽  
Solid Organ ◽  
Comprehensive Review ◽  
Long Term Treatment

In recent decades, solid organ transplantation (SOT) has increased the survival and quality of life for patients with end-stage organ failure by providing a potentially long-term treatment option. Although the availability of organs for transplantation has increased throughout the years, the demand greatly outweighs the supply. One possible solution for this problem is to extend the potential donor pool by using extended criteria donors. However, organs from such donors 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. This can be overcome by further investigating donor preconditioning strategies, graft perfusion and storage and by finding novel therapeutic agents that could reduce IRI. relaxin (RLX) is a peptide hormone with antifibrotic, antioxidant, anti-inflammatory and cytoprotective properties. The main research until now focused on heart failure; however, several preclinical studies showed its potentials for reducing IRI in SOT. The aim of this comprehensive review is to overview currently available literature on the possible role of RLX in reducing IRI and its positive impact on SOT.

scholarly journals Medical Gases: A Novel Strategy for Attenuating Ischemia—Reperfusion Injury in Organ Transplantation?

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Arunotai Siriussawakul ◽  
Lucinda I. Chen ◽  
John D. Lang
Keyword(s):  
Nitric Oxide ◽  
Carbon Monoxide ◽  
Hydrogen Sulfide ◽  
Reperfusion Injury ◽  
Organ Transplantation ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Inhaled Nitric Oxide ◽  
Clinical Consequence ◽  
Solid Organ

Ischemia reperfusion injury (IRI) is an inevitable clinical consequence in organ transplantation. It can lead to early graft nonfunction and contribute to acute and chronic graft rejection. Advanced molecular biology has revealed the highly complex nature of this phenomenon and few definitive therapies exist. This paper reviews factors involved in the pathophysiology of IRI and potential ways to attenuate it. In recent years, inhaled nitric oxide, carbon monoxide, and hydrogen sulfide have been increasingly explored as plausible novel medical gases that can attenuate IRI via multiple mechanisms, including microvascular vasorelaxation, reduced inflammation, and mitochondrial modulation. Here, we review recent advances in research utilizing inhaled nitric oxide, carbon monoxide, and hydrogen sulfide in animal and human studies of IRI and postulate on its future applications specific to solid organ transplantation.

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