Kidney Transplantation: Mechanism of Ischemia-Reperfusion Injury and HLA Matching and Rejection Mechanism

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Background

Kidney transplantation is one of the most remarkable medical achievements of the 20th century and is regarded as the peak of medicine in the 21st century. These achievements are attributed to the unremitting efforts of countless predecessors, especially in the past half-century, who have overcome numerous obstacles, and organ transplantation has finally become the main clinical treatment for end-stage organ failure.

Kidney transplantation is the most mature and effective organ transplantation among all solid organ transplantations. However, there are still a series of problems in the implementation of kidney transplantation, which seriously affect the transplantation effect. Among them, prevention and treatment of infection, recurrence of transplanted kidney disease, tissue matching technology, kidney transplantation for sensitized patients, prevention and treatment of rejection, and application of marginal donor kidney are the key technologies affecting the further improvement of kidney transplantation effects in this field. How to make breakthroughs in these key technologies is an important direction in the field of kidney transplantation in the future.

Ischemia-reperfusion injury (IRI) is an inevitable risk factor for kidney transplantation. The contradiction between the needs of donors and recipients is increasingly aggravated, which increases the proportion of marginal donor organs with poor tolerance to IRI applied in organ transplantation, leading to a significant increase in the incidence of IRI-related complications, such as delayed graft function recovery (DGF), primary graft nonfunction (PNF), and early acute graft rejection (AR). Therefore, how to alleviate and repair donor kidney IRI and how to reduce postoperative complications is one of the most concerning problems in the field of kidney transplantation.

The HLA system is the most complex polymorphic system in humans. Since the discovery of the first HLA, HLAs have become an important emerging research field in immunogenetics, immunobiology, and biochemistry. By quantifying the amount of donor-recipient HLA mismatch, HLA typing has become one of the most important risk assessment tools for predicting allogeneic HLA recognition. Structural analysis of crystalized antibody-HLA complexes has indicated that antibody-binding specificity is determined by a structure consisting of a few amino acids on the HLA (termed the functional epitope). HLA epitope ('eplets' in HLA Matchmaker) matching has become the focus of conversations regarding organ transplantation. HLA eplets matching is associated with better allograft outcome and prevents dnDSA generation, and antibody-verified mismatched eplet determine the risk of kidney transplant loss. However, not all HLA eplet mismatches cause antibody responses and rejection. Therefore, identifying non-immunogenic HLA eplets mismatches that do not lead to transplant rejection and applying them to donor selection is an important challenge in the field of transplantation.

Herein, two main problems must be faced. The first lies in the mechanism of ischemia-reperfusion injury in kidney transplantation, and the second regards the study on HLA matching and rejection mechanism. This Research Topic aims to focus attention on the state of advance of these two research lines. Our target is to understand the latest frontier research on the main hot issues in the field of kidney transplantation and analyze the key issues that have not yet been solved and the development direction of kidney transplantation in the future.

We welcome the submissions of Original Research, Review, and Case Report articles focusing on, but not limited to, the following topics related to cutting-edge basic and clinical research in the field of kidney transplantation:
• Mechanism of graft rejection
• Immune cell and graft rejection
• Antibody-mediated rejection (AMR)
• Donor-specific antibodies (DSA)
• Organ ischemia-reperfusion injury mechanism
• Immune tolerance
• Stem cell transplantation
• Islet cell transplantation
• HLA matching
• Model of organ transplantation
• Special kidney transplantation: children, ABOi, combined liver and kidney transplantation, combined pancreas and kidney transplantation, Living relative renal transplantation, kidney transplantation in sensitized patients, organ evaluation, acquisition and preservation for cadaver kidney transplantation et al.

Keywords: Kidney Transplantation, Mechanism, Ischemia-Reperfusion Injury, HLA Matching, Rejection Mechanism

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