Emerging role of T and B cells in preservation injury

PURPOSE OF REVIEW: The preservation of solid organs during transport for transplantation causes ischemic injury that initiates a cascade of deleterious effects. Subsequent reperfusion of the organ brings an inflammatory response from the host that involves the innate and adaptive arms of the immune system. Current organ preservation strategies are aimed at limiting structural and metabolic damage. New research developments have identified T and B cells as novel therapeutic targets for ischemic injury. RECENT FINDINGS: The important role of lymphocytes in modulating allograft injury was unexpected and has now been shown to occur in kidney, lung, liver, intestine and brain. Targeting T and B cells, through depletion or inhibition, has afforded protection in many different models of ischemia/reperfusion injury. Further study has revealed both deleterious and protective roles for T and B cells. SUMMARY: Targeting T and B cells could improve organ outcomes after preservation and ischemic injury. The optimal timing and strategy for therapeutic intervention has yet to be determined. The routine use of therapeutically modulating lymphocytes, in the donor, recipient, or both, seems likely in the near future. Preventing injury and improving recovery from acute ischemic damage is expected to translate into improved short and long-term transplant outcomes.