Branchereau J, Barrou B
Service d'Urologie, CHU de Nantes - Hôtel-Dieu, 1 place Alexis Ricordeau, 44093 Nantes Cedex 1, France.
INSERM, U1087, Ischémie-reperfusion en transplantation d'organe : mécanismes et innovations thérapeutiques, Poitiers ; université de Poitiers, faculté de Médecine et de Pharmacie, 86021 Poitiers, France.
Prog Urol. 2014 Jun;24 Suppl 1:S26-30. doi: 10.1016/S1166-7087(14)70060-0.
Ischemia-reperfusion injury is a complex physiological process responsible for delayed renal function or primary graft non-function, explicitly when kidney allograft are issued from expanded criteria donor. The purpose of this review is to detail the detrimental phenomenons altering kidney allograft's integrity in brain dead donor, therefore suggesting pharmacological interventions aiming to reduce ischemia-reperfusion injuries and improving transplantation outcome. This ischemia-reperfusion phenomenon must therefore be anticipated through the whole procedure starting at the stage of conditioning of the potential donor. Hormonal and haemodynamic consequences of brain death modify perfusion and oxygenation conditions of the organs Thus, after describing the autonomic, metabolic, endocrine and chemokine storm occurring during brain death, the authors focus on strategies to prevent hemodynamic instability in the donor and to limit the consequences of hormonal and immunological changes on organs that will eventually be transplanted.
缺血再灌注损伤是一个复杂的生理过程，可导致肾功能延迟恢复或原发性移植肾功能丧失，特别是当肾脏同种异体移植来自扩大标准供体时。本综述的目的是详细阐述改变脑死亡供体中肾脏同种异体移植完整性的有害现象，从而提出旨在减少缺血再灌注损伤和改善移植结果的药物干预措施。因此，必须在整个过程中，从潜在供体的预处理阶段开始，就预见到这种缺血再灌注现象。脑死亡的激素和血流动力学后果会改变器官的灌注和氧合状况。因此，在描述脑死亡期间发生的自主神经、代谢、内分泌和趋化因子风暴之后，作者重点关注预防供体血流动力学不稳定以及限制激素和免疫变化对最终将被移植器官的影响的策略。
