Renal Warm Ischemia in Organ Donors After Circulatory Death

• Type: Article in International Scientific Journal
• Date: 2021

Authors

Santos Dias, F (Author) Other; Metelo Coimbra, C (Author) Other; Roncon-Albuquerque R Jr (Author) FMUP

Journal

The Journal is awaiting validation by the Administrative Services.

Title: Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation

Vol. 19

Pages: 179-189

ISSN: 2146-8427

Publisher: NLM (Medline)

Indexing

Scopus - 1 Citation

Other information

Authenticus ID: P-00T-PJD

DOI: 10.6002/ect.2020.0081

Abstract (EN): Chronic kidney disease is the most common type of organ failure worldwide, with a prevalence of 13.4% for all stages. Organ transplant is the only curative option for end-stage kidney failure. However, the shortage of organ donors remains a major obstacle in organ transplant, with donation after circulatory death being the most viable path to increasing the donor pool. The circumstances that surround this type of donation are different from donation after brain death, namely concerning warm ischemia times, which are longer and may preclude a successful transplant. This article describes the pathophysiology of warm ischemia and summarizes recent developments in technological and methodological practices that mitigate the mechanisms of warm ischemia. Anoxia, mitochondrial dysfunction, calcium overload, oxidative and nitrosative stress, immune response, and no reflow are the main mechanisms by which ischemia leads to cell death and organ dysfunction. In situ oxygenated recirculation, abdominal normothermic organ recirculation, abdominal hypothermic organ recirculation, and ex vivo machine perfusion ensure continued organ perfusion and prevent prolonged warm ischemia in organ donation. These practices, coupled with optimizations in the identification and assessment of potential donors after circulatory death, may lead to a significant increase in the number and success rates of organ transplant worldwide.

Language: English

Type (Professor's evaluation): Scientific