[Ischemia-reperfusion. Preservation solution and hypothermic machine perfusion].
OBJECTIVE
To describe ischemia-reperfusion mechanisms, the impact on kidney graft and strategies developed to minimize ischemia-reperfusion damages.


METHODS
An exhaustive systematic review of the scientific literature was performed in the Medline database (http://www.ncbi.nlm.nih.gov) and Embase (http://www.embase.com) using different associations of the following keywords: ischemia-reperfusion; organ preservation; hypothermic machine perfusion; renal transplantation. Publications obtained were selected based on methodology, language, date of publication and relevance. Prospective and retrospective studies, in English or French, review articles; meta-analysis and guidelines were selected and analyzed. This search found 1293 articles. After reading titles and abstracts, 88 were included in the text, based on their relevance.


RESULTS
Ischemia-reperfusion injuries occur when blood supply of an organ is interrupted or drastically reduced. Ischemic damages started immediately after arterial clamping in donor, persist during cold ischemia time, and are increased after reperfusion because of increased oxygen levels, organ warming and recipient cell infiltration. Besides metabolic and biologic impact, IR induced dramatic immunologic impact through immunologic cells activation.


CONCLUSIONS
Knowledge of IR mechanisms is crucial to improve organ storage strategies and to decreased impact of IR on long-term graft and patient survival. Hypothermic machine perfusion was associated with prolonged graft survival versus cold storage. Principles and results of hypothermic machine perfusion will be reported.
Département d'urologie, néphrologie et transplantation rénale, GH Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Faculté de médecine, université Paris VI Pierre-et-Marie-Curie, 91-105, boulevard de l'Hôpital, 75013 Paris, France; Inserm U 1082 Poitiers, INRA plateforme IBiSA, 17700 Surgères, France. Electronic address: benoit.barrou@aphp.fr.
B
B
Barrou
Inserm U 1082 Poitiers, INRA plateforme IBiSA, 17700 Surgères, France; Agence de la biomédecine, 1, avenue du Stade-de-France, 93210 Saint-Denis, France.
N
N
Chatauret
Inserm U 1082 Poitiers, INRA plateforme IBiSA, 17700 Surgères, France; Service de biochimie, CHU de Poitiers, 2, rue de la Milétrie, CS 90577, 86000 Poitiers, France; Université de Poitiers, 15, rue de l'Hôtel-Dieu, 86000 Poitiers, France.
T
T
Hauet
Service d'urologie et transplantation rénale, CHU de Montpellier, 34090 Montpellier, France; Université de Montpellier, 34090 Montpellier, France.
R
R
Thuret
Service d'urologie et transplantation rénale, CHRU de Besançon, 25000 Besançon, France; Université de Franche-Comté, 25000 Besançon, France; Inserm UMR 1098, BP 1987, 25020 Besançon cedex, France.
F
F
Kleinclauss
Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France; Université Paris-Descartes, 12, rue de l'École-de-Médecine, 75006 Paris, France.
M-O
MO
Timsit
Inserm U 1082 Poitiers, INRA plateforme IBiSA, 17700 Surgères, France; Service d'urologie et chirurgie de la transplantation, hôpital E.-Herriot, HCL, 5, place d'Arsonval, 69437 Lyon cedex, France.
R
R
Codas
Département d'urologie, néphrologie et transplantation rénale, GH Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Inserm U 1082 Poitiers, INRA plateforme IBiSA, 17700 Surgères, France; Service d'urologie et chirurgie de la transplantation, hôpital E.-Herriot, HCL, 5, place d'Arsonval, 69437 Lyon cedex, France.
X
X
Matillon
Inserm U 1082 Poitiers, INRA plateforme IBiSA, 17700 Surgères, France; Service d'urologie et chirurgie de la transplantation, hôpital E.-Herriot, HCL, 5, place d'Arsonval, 69437 Lyon cedex, France; Université de Lyon I, 69622 Lyon, France.
L
L
Badet
D006801:Humans; D007036:Hypothermia, Induced; D016030:Kidney Transplantation; D009926:Organ Preservation / Q000379:methods*; D019188:Organ Preservation Solutions; D010477:Perfusion / Q000295:instrumentation; D015427:Reperfusion Injury / Q000517:prevention & control*
D019188:Organ Preservation Solutions
Cellules endothéliales; Hypothermic machine perfusion; Insuffisance rénale; Ischemia-reperfusion; Lésions d’ischémie–reperfusion; Machines de perfusion; Organ preservation; Préservation d’organe; Renal transplantation; Transplantation rénale