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  • Review Article
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New strategies to optimize kidney recovery and preservation in transplantation

Nature Reviews Nephrology volume 8, pages 339–347 (2012)Cite this article

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Abstract

Optimizing kidney preservation is a primary issue in transplantation, particularly in relation to new donor sources, such as expanded criteria donors (ECDs) and donation after cardiac death (DCD). Kidneys from these donors are highly sensitive to ischemia–reperfusion injuries—the emblematic lesions encountered during transplantation. Despite years of research, static cold storage, with solutions designed in the 1980s, remains the gold standard in kidney transplantation. This kind of preservation, however, is unable to fully protect an ECD or DCD kidney, highlighting the need for novel strategies to improve kidney preservation or promote kidney recovery. This Review provides an overview of the emerging strategies to prevent ischemia–reperfusion injuries in donor kidneys and describes strategies that are aimed at the donor, organ or recipient to improve graft outcome. These approaches include management of donors, preconditioning of the kidney, improvements in organ preservation solutions, postconditioning and regenerative therapies of the kidney graft following transplantation. In addition, machine perfusion provides an interesting opportunity to evaluate kidney graft quality before transplantation. Overall, a combination of therapeutic approaches seem to provide the best outcome, but preclinical studies using relevant models are needed before these approaches can be incorporated into clinical practice.

Key Points

  • Donor resuscitation affects kidney function before and after transplantation

  • Remote ischemic preconditioning to reduce ischemia–reperfusion injuries in donor kidneys needs to be evaluated in animal models of transplantation

  • Cold storage solutions based on polyethylene glycols or machine perfusion should be used to preserve grafts from all types of donors

  • Overexpression of proteins involved in downregulating inflammation, oxidative stress and apoptosis using ex vivo gene therapy improves graft survival or function in animal models of transplantation

  • Multivariate analysis of perfusates using proton NMR spectroscopy could reveal a factor that is predictive of graft outcome

  • Kidney transplantation outcome could be improved by remote ischemic postconditioning, pharmacological treatments or small interfering RNA therapy; stem cell therapy might promote kidney repair in the recipient

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Figure 1: Innovative treatments at the donor, graft preservation or recipient levels to improve kidney recovery.

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Authors and Affiliations

  1. Department of Medicine and Pharmacy, University of Poitiers, 6 rue de la Milétrie, F-86034, Poitiers, France

    Delphine Bon

  2. Department of Biochemistry, University Hospital CHU de Poitiers, 2 rue de la Milétrie, F-86021, Poitiers, France

    Nicolas Chatauret & Sébastien Giraud

  3. INSERM, U1082, 2 rue de la Milétrie, F-86021, Poitiers, France

    Raphael Thuillier, Frédéric Favreau & Thierry Hauet

Authors
  1. Delphine Bon
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  2. Nicolas Chatauret
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  3. Sébastien Giraud
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  4. Raphael Thuillier
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  5. Frédéric Favreau
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  6. Thierry Hauet
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Contributions

All the authors researched data for the article, contributed to the discussion of content and wrote the article. D. Bon and T. Hauet reviewed and/or edited the manuscript before submission.

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Correspondence to Thierry Hauet.

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Competing interests

T. Hauet is an independent inventor and holder of European patent EP1997374 with MacoPharma.

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Bon, D., Chatauret, N., Giraud, S. et al. New strategies to optimize kidney recovery and preservation in transplantation. Nat Rev Nephrol 8, 339–347 (2012). https://doi.org/10.1038/nrneph.2012.83

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