Prostaglandin E1 (PGE1) in renal transplantation

Prostaglandin E1 (PGE1), also known as Alprostadil, has been widely studied for its positive effects in solid organ transplantation. This pharmacological agent offers notable benefits in heart, lung, and particularly liver and kidney transplants, leading to improved outcomes such as reduced ischaemia-reperfusion injury (IRI), better graft viability, and increased patient survival.Evidence suggests that PGE1 is effective in organ preservation, reducing IRI, preventing primary graft dysfunction, improving both short- and long-term survival, shortening stays in the intensive care unit (ICU), and decreasing the risk of acute kidney failure, especially after liver transplantation.The principal biological actions of PGE1, which make the compound a valuable tool in organ transplantation are the following: it acts as a vasodilator, improving organ perfusion by reducing peripheral vascular resistance in the kidney and liver. Furthermore, it provides cytoprotection and has anti-inflammatory effects, shielding cells and tissues from IRI, lowering oxidative stress, and moderating immune responses. Finally, PGE1 has established anti-platelet and fibrinolytic properties: it inhibits platelet aggregation and promotes fibrinolysis, further protecting the graft, impacting the platelet activation, and especially their release of potassium ions during activation. These combined effects—vasodilation, cytoprotection, anti-inflammation, and anti-platelet activity—lead to better clinical outcomes, including faster organ function recovery, improved graft and patient survival, and a reduced risk of acute rejection.In kidney transplantation, PGE1 has been shown to protect organs when administered during machine perfusion (but not during cold storage). It enhances renal function during reperfusion, lowers vascular resistance, and limits IRI, when given immediately after reperfusion. By reducing oxidative stress and inflammation, PGE1 supports quicker graft recovery and better overall results.PGE1’s rapid metabolism and widespread distribution of its receptors, along with well-understood receptor-mediated effects, make it a promising option for perioperative management in solid organ transplantation. Its capacity to reduce IRI, suppress inflammation, and support vascular function is supported by strong pre-clinical and clinical evidence.In the present review, we summarize available evidence that position PGE1 as a valuable therapeutic adjunct for improving transplantation outcomes.