Consequences of transplant quality on chronic allograft nephropathy.
Using kidneys from expanded-criteria donors to alleviate organ shortage has raised concern on reduced transplant outcomes. In this paper, we review how critical donor-related factors such as donor age, brain death, and consequences of ischemia-reperfusion injury (IRI) determine graft quality and impact chronic allograft nephropathy. We propose that combinatorial effects of organ-intrinsic features associated with increasing age and unspecific injuries related to brain death and IRI will impact innate and adaptive immune responses. Future research will need to explore avenues to optimize donor management, organ preservation, adapted immunosuppressive strategies, as well as modifications of the allocation of suboptimal allografts.
Division of Transplant Surgery and Transplant Surgery Research Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Marc-Olivier
MO
Timsit
Xiaodong
X
Yuan
Bernhard
B
Floerchinger
Xupeng
X
Ge
Stefan G
SG
Tullius
D000818:Animals; D002908:Chronic Disease; D046148:Donor Selection; D006084:Graft Rejection / Q000209:etiology* / Q000276:immunology / Q000517:prevention & control; D006801:Humans; D007113:Immunity, Innate; D007165:Immunosuppression Therapy / Q000379:methods; D007674:Kidney Diseases / Q000209:etiology* / Q000276:immunology / Q000517:prevention & control; D016030:Kidney Transplantation / Q000009:adverse effects*; D018570:Risk Assessment; D012307:Risk Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D014184:Transplantation, Homologous; D016896:Treatment Outcome