Preconditioning, postconditioning, and remote conditioning in solid organ transplantation: basic mechanisms and...

Area of Science:

• Transplantation immunology
• Organ preservation
• Surgical research

Background:

• Ischemia and reperfusion (I/Rp) injury is a primary complication in solid organ transplantation, leading to graft dysfunction and increased patient mortality.
• This injury limits the use of marginal donor grafts, hindering efforts to expand the organ donor pool.
• Pre-, post-, and remote conditioning strategies offer potential protective benefits against I/Rp injury in the transplant setting.

Purpose of the Study:

• To review current pre-, post-, and remote conditioning strategies employed in clinical solid organ transplantation.
• To discuss the mechanistic pathways underlying the protective effects of these conditioning protocols.
• To highlight the potential of conditioning to mitigate I/Rp injury and broaden donor pool utilization.

Main Methods:

• Comprehensive literature review of pre-, post-, and remote conditioning strategies in solid organ transplantation.
• Analysis of experimental and clinical data on the efficacy of conditioning protocols.
• Exploration of the molecular and cellular mechanisms involved in I/Rp injury and conditioning-mediated protection.

Main Results:

• Conditioning strategies show promise in reducing I/Rp injury and improving graft outcomes in experimental models.
• Clinical translation of these strategies remains limited, with few protocols established in routine practice.
• A variety of mechanistic pathways, including inflammatory modulation and antioxidant defense, are implicated in conditioning effects.

Conclusions:

• Pre-, post-, and remote conditioning represent a promising avenue for improving solid organ transplantation outcomes.
• Further research and clinical validation are needed to overcome barriers to the widespread adoption of conditioning protocols.
• Successful implementation of conditioning could significantly enhance graft survival and expand the availability of transplantable organs.