Tempo de Isquemia Fria no Transplante Renal: Fisiopatologia, Impacto Clínico e Estratégias Emergentes de Preservação – Uma Revisão Narrativa
Palavras-chave:
Transplante Renal, Isquemia a Frio, Função Tardia do EnxertoResumo
A doença renal crônica permanece como um importante desafio global de saúde, e o transplante renal é o tratamento de escolha para pacientes com doença em estágio terminal. Entre os fatores modificáveis que influenciam os desfechos do enxerto, o tempo de isquemia a frio (TIF) desempenha um papel central na determinação do desempenho precoce do aloenxerto. Um TIF prolongado exacerba a lesão de isquemia-reperfusão por meio da depleção metabólica, estresse oxidativo, disfunção endotelial e ativação da imunidade inata, aumentando assim o risco de função tardia do enxerto e subsequente comprometimento do enxerto. Esta revisão narrativa sintetiza criticamente as evidências atuais sobre os mecanismos fisiopatológicos que ligam o TIF à disfunção do enxerto renal, bem como as estratégias contemporâneas de preservação e os biomarcadores emergentes de lesão precoce. A literatura demonstra consistentemente uma associação dependente do tempo entre o TIF prolongado e desfechos adversos pós-transplante, embora a magnitude do efeito varie de acordo com o perfil do doador e o método de preservação. No contexto da expansão dos critérios de doação e da logística de transplante cada vez mais complexa, a otimização do TIF permanece como um alvo fundamental e potencialmente modificável para melhorar o desempenho do enxerto e a utilização de recursos. Estudos futuros que integrem tecnologias avançadas de preservação e biomarcadores sensíveis são necessários para refinar a estratificação de risco e orientar o manejo personalizado do enxerto.
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Copyright (c) 2026 Alene Barros de Oliveira, Bruna Ribeiro Duque, Mac Dionys Rodrigues da Costa, Cauan Farias Ananias, Mateus Oliveira Fernandes, Emanuel Paula Magalhães, Tiago Lima Sampaio
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