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To review the basic mechanisms involved during hypothermia and reperfusion, with special attention paid to efforts being made in refining solutions and the molecular characterization of cells during preservation.Several graft-related molecules have been identified as correlating with early graft dysfunction and/or poor outcome in the immediate posttransplant period. Also, different inhibitors have been utilized to ameliorate the preservation-induced injury, alone or in combination with different preservation solutions.Preservation-induced injury is a major contributing factor to early graft dysfunction in organ recipients. The success of organ transplantation is critically dependent on the quality of the donor organ. Donor-organ quality, in turn, is determined by a variety of factors, including donor age, donor management prior to organ procurement, the duration of hypothermic storage, and perfusion techniques utilized to protect organs from ischemia/reperfusion injury, which in turn cause a dramatic reprogramming of cell metabolism during organ transplantation. The expression of a number of inflammatory genes has been associated with early graft dysfunction and/or poor outcome in the immediate postoperative period. Some therapeutic manipulations have been demonstrated to be of significance in attaining near-normal organ function after transplantation.