Bilirubin, a new therapeutic for kidney transplant?

Vikram L. Sundararaghavan, Sivjot Binepal, David E. Stec, Puneet Sindhwani, Terry D. Hinds

Research output: Contribution to journalReview articlepeer-review

28 Scopus citations


In patients with end-stage renal disease, kidney transplantation has been associated with numerous benefits, including increased daily activity, and better survival rates. However, over 20% of kidney transplants result in rejection within five years. Rejection is primarily due to a hypersensitive immune system and ischemia/reperfusion injury. Bilirubin has been shown to be a potent antioxidant that is capable of potentially reversing or preventing damage from reactive oxygen species generated from ischemia and reperfusion. Additionally, bilirubin has several immunomodulatory effects that can dampen the immune system to promote organ acceptance. Increased bilirubin has also been shown to have a positive impact on renal hemodynamics, which is critical post-transplantation. Lastly, bilirubin levels have been correlated with biomarkers of successful transplantation. In this review, we discuss a multitude of potentially beneficial effects that bilirubin has on kidney acceptance of transplantation based on numerous clinical trials and animal models. Exogenous bilirubin delivery or increasing endogenous levels pre- or post-transplantation may have therapeutic benefits.

Original languageEnglish
Pages (from-to)234-240
Number of pages7
JournalTransplantation Reviews
Issue number4
StatePublished - Oct 2018

Bibliographical note

Funding Information:
This work was supported by the National Institutes of Health L32MD009154 (T.D.H.), the National Heart, Lung, and Blood Institute [ K01HL-125445 ] (T.D.H.) and ( PO1HL-051971 ), [ HL088421 ] (D.E.S.), and the National Institute of General Medical Sciences ( P20GM-104357 ) (D.E.S.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Publisher Copyright:
© 2018 The Authors


  • Bilirubin
  • Gilbert's syndrome
  • Obesity
  • Oxidative stress
  • Renal transplant

ASJC Scopus subject areas

  • Transplantation


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