POSTISCHEMIC ORGAN DYSFUNCTION - A REVIEW

Objectives: The aim of this review is to consider the pathophysiology of ischaemia-reperfusion in organs that may be affected by either its local or remote consequences. Potential therapeutic strategies are als o considered. Design: A general discussion of the biochemical (includi ng oxygen free radicals, complement, cytokines) and cellular events (e ndothelial cells, neutrophils) responsible for the mediation of reperf usion injury is presented, with special consideration of the organ-spe cific differences affecting the myocardium, central nervous system, gu t, liver, kidney and skeletal muscle. Similarly, events which promote remote organ injury are described. Conclusions: Although it is recogni sed that prolonged ischaemia results in tissue and organ damage, the c oncept. of reperfusion-induced tissue injury, defined as tissue damage occurring as a direct consequence of revascularisation, is relatively recent. Such events may increase the morbidity and mortality of patie nts undergoing vascular reconstruction, trauma surgery and transplanta tion. A clear understanding of the factors responsible for its develop ment is therefore vital if protocols that reduce its impact are to be developed.