ABSTRACT
Despite the fact that a significant fraction of kidney graft dysfunctions observed after transplantation is due to ischemia-reperfusion injuries, there is still no clear consensus regarding optimal kidney preservation strategy. This stems directly from the fact that as of yet, the mechanisms underlying ischemia-reperfusion injury are poorly defined, and the role of each preservation parameter is not clearly outlined. In the meantime, as donor demography changes, organ quality is decreasing which directly increases the rate of poor outcome. This situation has an impact on clinical guidelines and impedes their possible harmonization in the transplant community, which has to move towards changing organ preservation paradigms: new concepts must emerge and the definition of a new range of adapted preservation method is of paramount importance. This review presents existing barriers in transplantation (e.g., temperature adjustment and adequate protocol, interest for oxygen addition during preservation, and clear procedure for organ perfusion during machine preservation), discusses the development of novel strategies to overcome them, and exposes the importance of identifying reliable biomarkers to monitor graft quality and predict short and long-term outcomes. Finally, perspectives in therapeutic strategies will also be presented, such as those based on stem cells and their derivatives and innovative models on which they would need to be properly tested.
Subject(s)
Kidney Transplantation , Kidney , Organ Preservation/methods , Perfusion/methods , Reperfusion Injury/prevention & control , Animals , Humans , Organ Preservation/adverse effects , Perfusion/adverse effects , Practice Guidelines as Topic , Reperfusion Injury/metabolism , Reperfusion Injury/pathologyABSTRACT
Damage to the medial frontal cortex in rats results in a learning deficit on a reinforced alternation task. The rate of recovery from this deficit was accelerated by transplantation of either adult or embryonic frontal cortex, provided that a delay was introduced between injury and transplantation. The rates of recovery for both delayed embryonic and adult transplants did not differ from the undamaged group. In contrast, transplants of embryonic frontal cortex immediately after ablation did not accelerate the rate of recovery. The accelerated rate of behavioral recovery on the reinforced alternation task appeared to correlate with transplant survival.
