Endothelial Dysfunction in Kidney Transplantation

• Main Authors: Héloïse Cardinal, Mélanie Dieudé, Marie-Josée Hébert
• Format: Article
• Language: English
• Published: Frontiers Media S.A. 2018-05-01
• Series: Frontiers in Immunology
• Subjects: kidney transplantation; endothelial injury; apoptosis; necroptosis; alloantibodies; autoantibodies
• Online Access: https://www.frontiersin.org/article/10.3389/fimmu.2018.01130/full

Kidney transplantation entails a high likelihood of endothelial injury. The endothelium is a target of choice for injury by ischemia-reperfusion, alloantibodies, and autoantibodies. A certain degree of ischemia-reperfusion injury inevitably occurs in the immediate posttransplant setting and can manifest as delayed graft function. Acute rejection episodes, whether T-cell or antibody-mediated, can involve the graft micro- and macrovasculature, leading to endothelial injury and adverse long-term consequences on graft function and survival. In turn, caspase-3 activation in injured and dying endothelial cells favors the release of extracellular vesicles (apoptotic bodies and apoptotic exosome-like vesicles) that further enhance autoantibody production, complement deposition, and microvascular rarefaction. In this review, we present the evidence for endothelial injury, its causes and long-term consequences on graft outcomes in the field of kidney transplantation.