Ischaemia reperfusion injury: mechanisms of progression to chronic graft dysfunction

Gerhard R. Situmorang, Neil S. Sheerin

Research output: Contribution to journalReview articlepeer-review

22 Citations (Scopus)

Abstract

The increasing use of extended criteria organs to meet the demand for kidney transplantation raises an important question of how the severity of early ischaemic injury influences long-term outcomes. Significant acute ischaemic kidney injury is associated with delayed graft function, increased immune-associated events and, ultimately, earlier deterioration of graft function. A comprehensive understanding of immediate molecular events that ensue post-ischaemia and their potential long-term consequences are key to the discovery of novel therapeutic targets. Acute ischaemic injury primarily affects tubular structure and function. Depending on the severity and persistence of the insult, this may resolve completely, leading to restoration of normal function, or be sustained, resulting in persistent renal impairment and progressive functional loss. Long-term effects of acute renal ischaemia are mediated by several mechanisms including hypoxia, HIF-1 activation, endothelial dysfunction leading to vascular rarefaction, sustained pro-inflammatory stimuli involving innate and adaptive immune responses, failure of tubular cells to recover and epigenetic changes. This review describes the biological relevance and interaction of these mechanisms based on currently available evidence.

Original languageEnglish
Pages (from-to)951-963
Number of pages13
JournalPediatric Nephrology
Volume34
Issue number6
DOIs
Publication statusPublished - 1 Jun 2019

Keywords

  • Acute ischaemic injury
  • Chronic graft dysfunction
  • Delayed graft function
  • Endothelial dysfunction
  • HIF-1
  • Hypoxia
  • Kidney transplantation

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