Targeting Ischemia-reperfusion injury in liver transplant rejuvenation

Background: Hepatic ischemia-reperfusion injury (HIRI) is a multifaceted pathophysiological process involving a cascade of interconnected cellular events. The initial ischemic stress, followed by the reestablishment of blood circulation to the liver, triggers a feed-forward innate immune-driven resp...

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Main Authors: Kenneth J. Dery, Fady Kaldas, Jerzy W. Kupiec-Weglinski
Format: Article
Language:English
Published: Elsevier 2025-06-01
Series:Transplantation Reports
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Online Access:http://www.sciencedirect.com/science/article/pii/S245195962500006X
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author Kenneth J. Dery
Fady Kaldas
Jerzy W. Kupiec-Weglinski
author_facet Kenneth J. Dery
Fady Kaldas
Jerzy W. Kupiec-Weglinski
author_sort Kenneth J. Dery
collection DOAJ
description Background: Hepatic ischemia-reperfusion injury (HIRI) is a multifaceted pathophysiological process involving a cascade of interconnected cellular events. The initial ischemic stress, followed by the reestablishment of blood circulation to the liver, triggers a feed-forward innate immune-driven response that exacerbates the hepatocellular injury. HIRI poses a significant clinical challenge in liver transplantation (LT), as it can result in tissue damage, organ dysfunction, and poor clinical outcomes. Methods and results: This review highlights current key issues in HIRI translational research, as revealed by recent bibliometric studies. It examines the mechanisms that facilitate homeostatic regulation after HIRI. Additionally, it addresses refined pharmacological strategies aimed at mitigating oxidative stress and inflammation. Hot topic areas in HIRI research include autophagy, donation after circulatory death, and NLRP3-dependent inflammasome activation following LT. New pharmacological agents, such as anti-oxidative compounds, metabolic modulators, and plant-derived compounds, are being explored to influence inflammatory responses. There is a strong clinical emphasis on broadening the donor pool by utilizing marginal donor grafts and advanced machine perfusion techniques. Enhancing translational research through the development of human-relevant organoids or ex vivo liver perfusion systems is essential for connecting laboratory discoveries with clinical practices in life-saving surgical procedures. Conclusion: A comprehensive approach that emphasizes the regulatory mechanisms of cellular responses to oxygen stress and immune cell activation, alongside innovative donor organ preservation, like machine perfusion, will shape the future direction of HIRI research by enhancing graft viability and revitalizing suboptimal donor organs.
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spelling doaj-art-684d337f4135489aae2b4ee4a7dff2c42025-08-20T03:13:48ZengElsevierTransplantation Reports2451-95962025-06-0110210017610.1016/j.tpr.2025.100176Targeting Ischemia-reperfusion injury in liver transplant rejuvenationKenneth J. Dery0Fady Kaldas1Jerzy W. Kupiec-Weglinski2Corresponding author.; Department of Surgery, University of California Los Angeles, Los Angeles, CA 90095, USADepartment of Surgery, University of California Los Angeles, Los Angeles, CA 90095, USADepartment of Surgery, University of California Los Angeles, Los Angeles, CA 90095, USABackground: Hepatic ischemia-reperfusion injury (HIRI) is a multifaceted pathophysiological process involving a cascade of interconnected cellular events. The initial ischemic stress, followed by the reestablishment of blood circulation to the liver, triggers a feed-forward innate immune-driven response that exacerbates the hepatocellular injury. HIRI poses a significant clinical challenge in liver transplantation (LT), as it can result in tissue damage, organ dysfunction, and poor clinical outcomes. Methods and results: This review highlights current key issues in HIRI translational research, as revealed by recent bibliometric studies. It examines the mechanisms that facilitate homeostatic regulation after HIRI. Additionally, it addresses refined pharmacological strategies aimed at mitigating oxidative stress and inflammation. Hot topic areas in HIRI research include autophagy, donation after circulatory death, and NLRP3-dependent inflammasome activation following LT. New pharmacological agents, such as anti-oxidative compounds, metabolic modulators, and plant-derived compounds, are being explored to influence inflammatory responses. There is a strong clinical emphasis on broadening the donor pool by utilizing marginal donor grafts and advanced machine perfusion techniques. Enhancing translational research through the development of human-relevant organoids or ex vivo liver perfusion systems is essential for connecting laboratory discoveries with clinical practices in life-saving surgical procedures. Conclusion: A comprehensive approach that emphasizes the regulatory mechanisms of cellular responses to oxygen stress and immune cell activation, alongside innovative donor organ preservation, like machine perfusion, will shape the future direction of HIRI research by enhancing graft viability and revitalizing suboptimal donor organs.http://www.sciencedirect.com/science/article/pii/S245195962500006XCEACAM1FerroptosisIschemia-Reperfusion InjuryLiverNLRP3Normothermic machine perfusion
spellingShingle Kenneth J. Dery
Fady Kaldas
Jerzy W. Kupiec-Weglinski
Targeting Ischemia-reperfusion injury in liver transplant rejuvenation
Transplantation Reports
CEACAM1
Ferroptosis
Ischemia-Reperfusion Injury
Liver
NLRP3
Normothermic machine perfusion
title Targeting Ischemia-reperfusion injury in liver transplant rejuvenation
title_full Targeting Ischemia-reperfusion injury in liver transplant rejuvenation
title_fullStr Targeting Ischemia-reperfusion injury in liver transplant rejuvenation
title_full_unstemmed Targeting Ischemia-reperfusion injury in liver transplant rejuvenation
title_short Targeting Ischemia-reperfusion injury in liver transplant rejuvenation
title_sort targeting ischemia reperfusion injury in liver transplant rejuvenation
topic CEACAM1
Ferroptosis
Ischemia-Reperfusion Injury
Liver
NLRP3
Normothermic machine perfusion
url http://www.sciencedirect.com/science/article/pii/S245195962500006X
work_keys_str_mv AT kennethjdery targetingischemiareperfusioninjuryinlivertransplantrejuvenation
AT fadykaldas targetingischemiareperfusioninjuryinlivertransplantrejuvenation
AT jerzywkupiecweglinski targetingischemiareperfusioninjuryinlivertransplantrejuvenation