title: Strategies to optimize kidney recovery and preservation in transplantation: specific aspects in pediatric transplantation.
abstract: In renal transplantation, live donor kidney grafts are associated with optimum success rates due to the shorter period of ischemia during the surgical procedure. The current shortage of donor organs for adult patients has caused a shift towards deceased donors, often with co-morbidity factors, whose organs are more sensitive to ischemia-reperfusion injury, which is unavoidable during transplantation. Donor management is pivotal to kidney graft survival through the control of the ischemia-reperfusion sequence, which is known to stimulate numerous deleterious or regenerative pathways. Although the key role of endothelial cells has been established, the complexity of the injury, associated with stimulation of different cell signaling pathways, such as unfolded protein response and cell death, prevents the definition of a unique therapeutic target. Preclinical transplant models in large animals are necessary to establish relationships and kinetics and have already contributed to the improvement of organ preservation. Therapeutic strategies using mesenchymal stem cells to induce allograft tolerance are promising advances in the treatment of the pediatric recipient in terms of reducing/withdrawing immunosuppressive therapy. In this review we focus on the different donor management strategies in kidney graft conditioning and on graft preservation consequences by highlighting the role of endothelial cells. We also propose strategies for preventing ischemia-reperfusion, such as cell therapy.
authors.affiliation: Ischémie-Reperfusion en Transplantation Rénale, INSERM, U1082, Poitiers, 86000, France.
authors.forename: Tackwa
authors.initials: T
authors.lastname: Khalifeh
authors.forename: Edouard
authors.initials: E
authors.lastname: Baulier
authors.forename: Sylvain
authors.initials: S
authors.lastname: Le Pape
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerforne
authors.forename: Remy
authors.initials: R
authors.lastname: Coudroy
authors.forename: Souleymane
authors.initials: S
authors.lastname: Maiga
authors.forename: Thierry
authors.initials: T
authors.lastname: Hauet
authors.forename: Michel
authors.initials: M
authors.lastname: Pinsard
authors.forename: Frederic
authors.initials: F
authors.lastname: Favreau
mesh_terms: D002648:Child; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods*; D009926:Organ Preservation / Q000379:methods*; D010372:Pediatrics / Q000379:methods*; D014019:Tissue Donors / Q000600:supply & distribution*