Ischemia-reperfusion injury in deceased donor kidneys can directly damage nephrons and primes the immune system, increasing susceptibility to rejection.

“part of that is probably due to the the consequences just of the ischemia reperfusion injury and kind of literally knocking off some nephrons just from that process part of it also is as we've learned is that that ischemia reprofusion injury cascade that starts is a priming event for the immune system so not only do deceased donor kidneys kind of pound for pound compared to living donor kidneys take that initial hit from the ischemia perfusion injury they're also more prone to rejection”