During hypoxic condition, the activity of antioxidant enzymes, such as superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GSH-Px) is strongly impaired causing an exacerbated production of ROS when blood circulation is restored ( Therefore, the reestablishing of blood supply in reperfusion phase enhances several mechanisms that are more detrimental for renal parenchyma and include the burst of ROS, calcium overload, opening of the MPT pore, endothelial dysfunction and activation of coagulation and inflammatory response ( The ROS burst and mPTP opening cause an influx of water and solute that enhances mitochondrial swelling and the disruption of the outer membrane with the release of cytochrome C in the cytosol ( In addition, ROS induce direct damage to cellular macromolecules such as proteins, lipids and DNA, which consequently enhance cells to activate death mechanisms ( Considering the differences of oxygenation among several regions of renal parenchyma, it is obviously that the response of each cell depends on their location within the kidney ( The principal consequences of I/R injury are associated to profound alterations of renal epithelial cells that include brush border loss, cytoskeletal changes and rapid loss of surface markers and peculiar transport properties that enhance death mechanisms ( Endothelial cells are also involved in this context and are the first target of I/R injury ( Several studies underline the correlation between I/R injury, oxidative stress and graft outcomes ( New several polymorphisms in genes involved in oxidative stress have been associated with DGF, allowing better understanding of DGF pathophysiology and suggesting a possible explanation of the different outcomes between individuals in post-transplant course ( Given the strong link between oxidative stress, especially in cadaveric donors and poor transplantation outcomes, several studies have investigated the use of antioxidant therapy in kidney transplantation ( Table 1 )

Nikolic 2009)
Biswas, Saibal K., et al
High-concentration antioxidant research liquids require careful formulation review, raw material accountability, finished-product presentation checks, and professional storage expectations
People who are on anti-psychotic medication or chemotherapeutic drugs should not take glutathione tablets
Higher plants do not concentrate methylcobalamin from the soil, making them a poor source of the substance as compared with animal tissues