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

Weiss, S. and Kotsch, K. and Francuski, M. and Reutzel-Selke, A. and Mantouvalou, L. and Klemz, R. and Kuecuek, O. and Jonas, S. and Wesslau, C. and Ulrich, F. and Pascher, A. and Volk, H-D. and Tullius, S. G. and Neuhaus, P. and Pratschke, J. (2007) Brain death activates donor organs and is associated with a worse I/R injury after liver transplantation. AMERICAN JOURNAL OF TRANSPLANTATION, 7 (6). pp. 1584-1593. ISSN 1600-6135,

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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-1 alpha 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.

Item Type: Article
Uncontrolled Keywords: DELAYED GRAFT FUNCTION; NECROSIS-FACTOR-ALPHA; INFLAMMATORY MARKERS; ACUTE REJECTION; IMMUNOLOGICAL ACTIVATION; RENAL-ALLOGRAFTS; HEME OXYGENASE; RAT; EXPRESSION; SURVIVAL; brain death; cytokines; immunogenicity; inflammation; live transplantation; risk factors
Subjects: 600 Technology > 610 Medical sciences Medicine
Divisions: Medicine > Lehrstuhl für Chirurgie
Depositing User: Dr. Gernot Deinzer
Date Deposited: 02 Dec 2020 14:46
Last Modified: 02 Dec 2020 14:46
URI: https://pred.uni-regensburg.de/id/eprint/32631

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