Ischemia-reperfusion injury in transplantation: novel mechanisms and protective strategies

Solid organ transplantation remains the treatment of choice for many patients with end-stage organ failure. Because of the significant donor organ shortage, many transplant centers are using deceased donor allografts that are considered “marginal” and would have otherwise been discarded in previous years. In some instances, the use of these marginal grafts has resulted in inferior outcomes after transplantation. Ischemia-reperfusion injury (IRI) remains an important cause of organ dysfunction and allograft survival after transplantation. Despite many years of investigative research, there remains no standard treatment for IRI after solid organ transplantation. With the increased use of marginal allografts, there is a greater need to protect these organs from IRI, and researchers continue to seek novel mechanisms and strategies to minimize injury after transplantation. This review focuses on the recently identified mechanisms of IRI and novel protective strategies being studied to minimize IRI after transplantation.