Figure 1.

Stages of ischemia-reperfusion injury. Ischemia-reperfusion injury can be divided into three stages based on distinct molecular mechanisms: hypoxia, reoxygenation and reperfusion. Cut-off of the donor organ leads to hypoxia, which leads to changes in HIF levels. During reoxygenation, reactive oxygen species lead to massive cell death and endothelial dysfunction. When the graft is reperfused in the recipient, the immune system of the recipient can react to the graft and its immune cells and vice versa. Arrows indicate the relations between the different mechanisms. DAMPs, damage-associated molecular patterns; HIF, hypoxia inducible factor.