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Ischemia–Reperfusion Injury in Reconstructive Transplantation: An Undefined Conundrum

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The Science of Reconstructive Transplantation

Part of the book series: Stem Cell Biology and Regenerative Medicine ((STEMCELL))

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Abstract

Ischemia–reperfusion injury (IRI), a major complication of organ transplantation, tissue resection, and hemorrhagic shock, is a dynamic process that involves two interrelated phases of local ischemic insult and inflammation-mediated reperfusion injury. This chapter highlights recent mechanistic insights into innate–adaptive immune cross talk and cell activation cascades leading to inflammation-mediated damage in IR-stressed tissues, and considers their pathophysiological relevance in the emerging field of vascularized composite allotransplantation (VCA). The interlocked molecular signaling pathways in histologically divergent cell types, the IRI kinetics, and positive versus negative regulatory loops at the innate–adaptive immune interface are discussed. Current gaps in our knowledge and mechanistic aspects necessitating basic and translational research are stressed. Improved appreciation of cellular and molecular events, which trigger and sustain local inflammation responses in experimental models, are fundamental to developing innovative strategies for treating VCAs suffering from IR-inflammation/dysfunction following prolonged periods of ex vivo storage. Achieving these goals should pave the road to improving the clinical outcomes and possibly achieving the ultimate goal of imposing operational immune tolerance in transplant patients.

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Authors and Affiliations

  1. The Dumont-UCLA Transplant Center, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at University of California- Los Angeles, 77–120 CHS, 10833 Le Conte Ave, Los Angeles, CA, USA

    Jerzy W. Kupiec-Weglinski MD, PhD

  2. Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California- Los Angeles, Los Angeles, CA, USA

    Kodi Azari MD, FACS

Authors
  1. Jerzy W. Kupiec-Weglinski MD, PhD
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  2. Kodi Azari MD, FACS
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Corresponding author

Correspondence to Jerzy W. Kupiec-Weglinski MD, PhD .

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Editors and Affiliations

  1. Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

    Gerald Brandacher

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Kupiec-Weglinski, J., Azari, K. (2015). Ischemia–Reperfusion Injury in Reconstructive Transplantation: An Undefined Conundrum. In: Brandacher, G. (eds) The Science of Reconstructive Transplantation. Stem Cell Biology and Regenerative Medicine. Humana Press, New York, NY. https://doi.org/10.1007/978-1-4939-2071-6_22

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