Brain death activates donor organs and is associated with a worse I/R injury after liver transplantation.

Abstract

The majority of transplants are derived from donors who suffered from brain injury. There is evidence that brain death causes inflammatory changes in the donor. To define the impact of brain death, we evaluated the gene expression of cytokines in human brain dead and ideal living donors and compared these data to organ function following transplantation. Hepatic tissues from brain dead (n = 32) and living donors (n = 26) were collected at the time of donor laparotomy. Additional biopsies were performed before organ preservation, at the time of transplantation and one hour after reperfusion. Cytokines were assessed by real-time reverse transcriptase-polymerase chain reaction (RT-PCR) and cytometric bead array. Additionally, immunohistological analysis of tissue specimens was performed. Inflammatory cytokines including IL-6, IL-10, TNF-alpha, TGF-beta and MIP-1alpha were significantly higher in brain dead donors immediately after laparotomy compared to living donors. Cellular infiltrates significantly increased in parallel to the soluble cytokines IL-6 and IL-10. Enhanced immune activation in brain dead donors was reflected by a deteriorated I/R injury proven by elevated alanin-amino-transferase (ALT), aspartat-amino-transferase (AST) and bilirubin levels, increased rates of acute rejection and primary nonfunction. Based on our clinical data, we demonstrate that brain death and the events that precede it are associated with a significant upregulation of inflammatory cytokines and lead to a worse ischemia/reperfusion injury after transplantation.

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@article{Weiss2007BrainDA, title={Brain death activates donor organs and is associated with a worse I/R injury after liver transplantation.}, author={Sascha Weiss and Katja Kotsch and Maja Francuski and Anja Reutzel-Selke and L Mantouvalou and Roman Klemz and Osman K{\"{U}Ç{\"{U}K and Sven Jonas and C Wesslau and Frederick Ulrich and Andreas Pascher and H-D Volk and Stefan G Tullius and Peter Neuhaus and Johann Pratschke}, journal={American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons}, year={2007}, volume={7 6}, pages={1584-93} }