Cell death in kidney transplantation: Mechanisms and therapeutic perspectives

Area of Science:

• Nephrology
• Immunology
• Cell Biology

Background:

• Kidney transplantation is the preferred treatment for end-stage renal disease.
• Long-term graft survival is compromised by ischemia-reperfusion injury, rejection, and chronic allograft dysfunction.
• Regulated cell death pathways are increasingly recognized as key contributors to transplant injury.

Purpose of the Study:

• To review the mechanistic insights into regulated cell death in kidney transplantation.
• To summarize experimental and clinical evidence linking cell death to graft outcomes.
• To discuss therapeutic strategies targeting cell death pathways for improved transplant prognosis.

Main Methods:

• Literature review of mechanistic studies.
• Analysis of experimental and clinical evidence.
• Discussion of therapeutic interventions.

Main Results:

• Multiple regulated cell death pathways (apoptosis, necroptosis, pyroptosis, ferroptosis, autophagy) are involved in kidney transplant injury.
• These pathways interact to shape the immune microenvironment and influence graft fate.
• Emerging cell death forms (cuproptosis, parthanatos, NETosis) add complexity to transplant pathology.

Conclusions:

• Regulated cell death plays a critical role in kidney transplant outcomes.
• Targeting cell death pathways presents a novel therapeutic avenue.
• Integrating cell death modulation into precision medicine may enhance graft survival and patient prognosis.