Abstract
Ischemia—reperfusion injury is a major issue in kidney transplantation, as it has become more and more evident that its clinical expression, delayed graft function (DGF), has a significant impact on graft survival [1–3]. How such an early and short-lasting event can influence long-term transplant outcome is being investigated, and the links between reperfusion injury and early rejection or chronic allograft dysfunction are progressively explained (see refs 4 and 5 for review). The mechanisms of reperfusion injury have been extensively explored in recent years and several therapeutic options are emerging. These mainly target the production of reactive oxygen radicals, but many studies have also concentrated on the importance of adhesion molecules and the interest of their blockade in prevention of the reperfusion syndrome. Reperfusion injury is the result of a cascade of events, making the allograft an inflamed organ. A central step in the process is the activation of the graft endothelium and of circulating leukocytes, that enable them to adhere on the endothelial surface and to emigrate into the interstitium. Leukoendothelial interactions are mediated by complementary adhesion molecules on both sides; experiments in animal models of reperfusion injury by clamping of the renal artery have shown that the blockade by monoclonal antibodies (Moab) or antisense oligonucleotides, of the most important of these adhesion molecules, mainly those responsible for the strong phase of adhesion, could prevent ischemic acute renal failure and its histologic lesions. The use of the anti-adhesion molecule Moab has already been extended to human transplantation, and experience with two Moab, targeting respectively ICAM-1 and LFA-1, suggests a protective effect towards reperfusion injury. A pilot study only has been reported with the anti-ICAM-1 Moab [6], but the anti-LFA-1 antibody, Odulimomab, has been extensively evaluated through several multicenter randomized trials, that will be summarized.
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Hourmant, M., Soulillou, J.P. (1998). Interest in an anti-LFA-1 monoclonal antibody in the prevention of reperfusion injury in kidney transplantation. In: Touraine, J.L., Traeger, J., Bétuel, H., Dubernard, J.M., Revillard, J.P., Dupuy, C. (eds) Organ Allocation. Transplantation and Clinical Immunology, vol 30. Springer, Dordrecht. https://doi.org/10.1007/978-94-011-4984-6_24
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DOI: https://doi.org/10.1007/978-94-011-4984-6_24
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