Organ transplantation is still a relatively new field in medicine; although the first kidney transplant was performed in 1954, it was only with the development of immunosuppression in the 1980s that it became more widely utilised. There remains a chronic mismatch between the number of patients on waiting lists and the availability of suitable organs for transplantation, which some consider to be the greatest challenge in modern transplant medicine.
Strategies to expand the donor pool are crucial, including the use of organs from extended criteria donors (ECD) However, marginal grafts require very careful evaluation and are known to be susceptible to ischemia/reperfusion injury (IRI). IRI is one of the major risk factors for unfavourable outcomes after transplantation, resulting in short- and long-term complications, such as delayed graft function and acute or chronic rejection. In an effort to reduce IRI, a number of novel therapeutic approaches are being pursued, including donor preconditioning, the optimisation of organ perfusion and storing conditions, as well as the development of drugs targeting IRI, including melatonin, the main secretory produce of the pineal gland (Stiegler et al., 2018).