Lesión isquémica en riñones procurados. De la investigación básica a la clínica
Resumen
En el trasplante renal, la injuria orgánica comienza con los cambios fisiológicos propios de la muerte cerebral o la parada cardíaca y continúa en el implante. Luego de ser removido del donante, el órgano es mantenido por un corto período en condiciones no fisiológicas antes de ser definitivamente reperfundido al momento del trasplante. Durante este tiempo, una tormenta de procesos fisiopatológicos sucede, comenzando con alteración de la perfusión e isquemia asociada al mantenimiento del donante, corte circulatorio y preservación del órgano y luego continuando con el daño después de la reperfusión por generación de un estado pro-inflamatorio órgano-específico. Este complejo de procesos es llamado injuria por isquemia-reperfusión (IIR) y se manifiesta clínicamente con función retardada del injerto (FRI) o fallo primario del injerto (FPI) luego del trasplante. En esta revisión, inicialmente definiremos FRI con sus consecuencias adversas describiendo diferentes métodos diagnósticos. Luego discutiremos los mecanismos comprometidos en la fisiopatología de la primera etapa del complejo IIR, la lesión isquémica, generada durante el proceso de donación. Por supuesto, no siempre se podrá hacer una división debido que entendemos que en un mismo proceso de donación y trasplante se genera en su continuidad la injuria por isquemia y reperfusión. El trabajo se focalizará específicamente en los factores que se suceden alrededor de los tiempos inmediatos pretrasplante los cuales puedan influenciar específicamente sobre la isquemia de los riñones procurados.
Citas
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