Ischemic injury in procured kidneys. From basic research to the clinic

Abstract

In renal transplantation, organic injury begins with the physiological changes characteristic of brain death or cardiac arrest and continues at the implant. After being removed from the donor, the organ is maintained for a short period in non-physiological conditions before being definitively reperfused at the time of transplantation. During this time, a storm of pathophysiological processes occurs, beginning with altered perfusion and ischemia associated with donor maintenance, circulatory cut and preservation of the organ and then continuing with damage after reperfusion by generation of a pro-inflammatory organ -specific. This complex of processes is called ischemia-reperfusion injury (IRI) and manifests clinically with delayed graft function (DGF) or primary graft failure (PGF) after transplantation. In this review, we will initially define DGF with its adverse consequences describing different diagnostic methods. We will then discuss the mechanisms involved in the pathophysiology of the first stage of the IRI complex, the ischemic injury, generated during the donation process. Of course, a division can not always be made because we understand that in the same process of donation and transplantation, the injury due to ischemia and reperfusion is generated in its continuity. The work will focus specifically on the factors that occur around the immediate pre-transplant times which may specifically influence the ischemia of the sought kidneys.

Keywords

• trasplante renal
• lesión isquémica
• función retardada del injerto
• donante de riñón
• donantes de tejidos