title: Ischemia and reperfusion injury in renal transplantation: hemodynamic and immunological paradigms.
abstract: Ischemia and reperfusion injury is an inevitable event in renal transplantation. The most important consequences are delayed graft function, longer length of stay, higher hospital costs, high risk of acute rejection, and negative impact of long-term follow-up. Currently, many factors are involved in their pathophysiology and could be classified into two different paradigms for education purposes: hemodynamic and immune. The hemodynamic paradigm is described as the reduction of oxygen delivery due to blood flow interruption, involving many hormone systems, and oxygen-free radicals produced after reperfusion. The immune paradigm has been recently described and involves immune system cells, especially T cells, with a central role in this injury. According to these concepts, new strategies to prevent ischemia and reperfusion injury have been studied, particularly the more physiological forms of storing the kidney, such as the pump machine and the use of antilymphocyte antibody therapy before reperfusion. Pump machine perfusion reduces delayed graft function prevalence and length of stay at hospital, and increases long-term graft survival. The use of antilymphocyte antibody therapy before reperfusion, such as Thymoglobulin™, can reduce the prevalence of delayed graft function and chronic graft dysfunction.
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Lúcio Roberto
authors.initials: LR
authors.lastname: Requião-Moura
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Marcelino de Souza
authors.initials: Mde S
authors.lastname: Durão Junior
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Ana Cristina Carvalho de
authors.initials: AC
authors.lastname: Matos
authors.affiliation: Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Pacheco-Silva
mesh_terms: D051799:Delayed Graft Function / Q000503:physiopathology; D006084:Graft Rejection / Q000503:physiopathology; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007511:Ischemia / Q000276:immunology / Q000503:physiopathology / Q000517:prevention & control; D007668:Kidney / Q000098:blood supply*; D016030:Kidney Transplantation / Q000009:adverse effects*; D015427:Reperfusion Injury / Q000276:immunology / Q000503:physiopathology / Q000517:prevention & control; D012307:Risk Factors; D013997:Time Factors