title: New insights in intestinal ischemia-reperfusion injury: implications for intestinal transplantation.
abstract: OBJECTIVE
  Ischemia-reperfusion injury is inevitable during intestinal transplantation and can negatively affect the transplant outcome. Here, an overview is provided of the recent advances in the pathophysiological mechanisms of intestinal ischemia-reperfusion injury and how this may impact graft survival.
  
  
  RESULTS
  The intestine hosts a wide range of microorganisms and its mucosa is heavily populated by immune cells. Intestinal ischemia-reperfusion results in the disruption of the epithelial lining, affecting also protective Paneth cells (antimicrobials) and goblet cells (mucus), and creates a more hostile intraluminal microenvironment. Consequently, both damage-associated molecular patterns as well as pathogen-associated molecular patterns are released from injured tissue and exogenous microorganisms, respectively. These 'danger' signals may synergistically activate the innate immune system. Exaggerated innate immune responses, involving neutrophils, mast cells, platelets, dendritic cells, as well as Toll-like receptors and complement proteins, may shape the adaptive T-cell response, thereby triggering the destructive alloimmune response toward the graft and resulting in transplant rejection.
  
  
  CONCLUSIONS
  Innate immune activation as a consequence of ischemia-reperfusion injury may compromise engraftment of the intestine. More dedicated research is required to further establish this concept in man and to design more effective therapeutic strategies to better tolerize intestinal grafts.
authors: Department of Surgery, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, Maastricht, the Netherlands. kaatje.lenaerts@maastrichtuniversity.nl
authors: Kaatje
authors: K
authors: Lenaerts
authors: Laurens J
authors: LJ
authors: Ceulemans
authors: Inca H R
authors: IH
authors: Hundscheid
authors: Joep
authors: J
authors: Grootjans
authors: Cornelis H C
authors: CH
authors: Dejong
authors: Steven W M
authors: SW
authors: Olde Damink
mesh_terms: D006085:Graft Survival / Q000276:immunology; D006801:Humans; D007113:Immunity, Innate / Q000502:physiology*; D007410:Intestinal Diseases / Q000503:physiopathology*; D007422:Intestines / Q000637:transplantation*; D011183:Postoperative Complications; D015427:Reperfusion Injury / Q000503:physiopathology*