Hydrogen Sulfide Therapy for Improved Kidney Transplantation Outcomes

Kidney transplantation has become the preferred treatment option for patients with end-stage renal disease. Although it is a superior alternative to long-term hemodialysis, optimal kidney preservation prior to transplantation remains a major challenge, as the gold standard of renal graft preservation by static cold storage tion in University of Wisconsin (UW) solution on ice at 4 °C contributes to graft injury and long-term post-transplantation complications. An emerging strategy which holds great therapeutic promise against cold renal graft injury and limiting long-term post-transplant complications is supplementation of the cold UW preservation solution with hydrogen sulfide (H2S), the third established member of the gasotransmitter family. This novel pharmacological strategy has been demonstrated experimentally, with compelling success at different preservation temperatures (hypothermic, normothermic and subnormothermic) and preservation techniques such as static cold storage and machine perfusion, suggesting the need for pharmacological modification of existing preservation solutions beyond cold storage to improve the quality of renal graft preservation. This chapter presents an overview of organ graft preservation strategies prior to transplantation, with particular emphasis on the kidney as the most commonly transplantable organ and highly vulnerable to transplantation-induced injury. The chapter also discusses H2S as the future of renal graft preservation for a better transplantation outcome. A section of the chapter also highlights important lessons that can be learned from how nature protects the organs of mammalian hibernators from the damaging effects of repetitive cycle of cold ischemia and reperfusion.