New insight in the immune mechanisms in hyperuricemia after renal transplantation: a narrative review

X. Zhang, X.-Y. Zi, C. Hao

Department of Urology, Department of Rheumatology, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China. haochuan2003@sina.com

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• Transplantation

OBJECTIVE: Due to underlying allograft rejection and renal ischemia reperfusion injury (IRI) inducing renal injury, hyperuricemia (HUA) is one of the common complications after renal transplantation and may be a major contributor to reduced renal function. Currently, there are no uniform mechanisms of HUA after renal transplantation. This review aimed to figure out the immune mechanisms of HUA after renal transplantation and the molecular mechanisms of HUA-induced renal injury to provide new insights into renal function protection and prolonged survival time of grafts.

MATERIALS AND METHODS: The search terms included ‘Hyperuricemia’, ‘Renal transplantation’, ‘Urea acid’, ‘Gout’ ‘Graft Rejection’, ‘Graft Survival’. Databases including PubMed, Cochrane Library, Embase, Clinicaltrials.gov and China National Knowledge Infrastructure (CNKI) were searched for studies including mechanisms of hyperuricemia after renal transplantation from the beginning of databases to March 2022.

RESULTS: Our study reviews the immune mechanisms of HUA after renal transplantation. HUA induces renal injury mainly by renal inflammation, oxidative stress, and endothelial dysfunction. IRI contributes to increased inflammation in renal grafts, mediates the recruitment of various inflammatory cell types.

CONCLUSIONS: Due to underlying allograft rejection and IRI, renal transplant recipients are especially prone to HUA. HUA further reduces renal function and even graft loss. Treg targeting could be a novel therapeutic approach in renal transplantation.

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