title: Role of temperature in reconditioning and evaluation of cold preserved kidney and liver grafts.
abstract: OBJECTIVE
  Organ shortage in transplantation medicine forces surgical research toward the development of more efficient approaches in organ preservation to enable the application of 'less than optimal' grafts. This review summarizes current techniques aiming to recondition cold-stored organ grafts prior to transplantation to reduce reperfusion-induced tissue injury and improve postimplantation graft function.
  
  
  RESULTS
  End-ischemic reconditioning has classically been attempted by cold oxygenated perfusion. By contrast, evaluation of graft performance prior to transplantation might be facilitated by perfusion at higher temperatures, ideally at normothermia. A drastic temperature shift from cold preservation to warm perfusion, however, has been incriminated to trigger a so-called rewarming injury associated with mitochondrial alterations. A controlled gradual warming up during machine perfusion could enhance the restitution of cellular homeostasis and improve functional outcome upon warm reperfusion.
  
  
  CONCLUSIONS
  Machine perfusion after conventional cold storage is beneficial for ulterior function after transplantation. Cold grafts should be initially perfused at low temperatures allowing for restitution of cellular homeostasis under protective hypothermic limitation of metabolic turnover. Delayed slow rewarming of the organ might further mitigate rewarming injury upon reperfusion and also increases the predictive power of evaluative measures, taken during pretransplant perfusion.
authors.affiliation: aDepartment for Surgical Research bClinic for General, Visceral and Transplantation Surgery, University Hospital Essen, University Duisburg-Essen, Duisburg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Minor
authors.forename: Charlotte
authors.initials: C
authors.lastname: von Horn
authors.forename: Andreas
authors.initials: A
authors.lastname: Paul
mesh_terms: D003080:Cold Temperature; D015925:Cryopreservation / Q000379:methods*; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods*; D016031:Liver Transplantation / Q000379:methods*; D009926:Organ Preservation / Q000379:methods*; D010477:Perfusion / Q000379:methods*; D015424:Reperfusion / Q000379:methods*; D017694:Rewarming; D019737:Transplants / Q000637:transplantation*