Authors contributed equally to this manuscript.
Brain Death Activates Donor Organs and Is Associated with a Worse I/R Injury After Liver Transplantation
Version of Record online: 8 APR 2007
American Journal of Transplantation
Volume 7, Issue 6, pages 1584–1593, June 2007
How to Cite
Weiss, S., Kotsch, K., Francuski, M., Reutzel-Selke, A., Mantouvalou, L., Klemz, R., Kuecuek, O., Jonas, S., Wesslau, C., Ulrich, F., Pascher, A., Volk, H.-D., Tullius, S. G., 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: 1584–1593. doi: 10.1111/j.1600-6143.2007.01799.x
- Issue online: 8 APR 2007
- Version of Record online: 8 APR 2007
- Received 22 June 2006, revised 26 September 2006 and accepted for publication 12 February 2007
- Brain death;
- live transplantation;
- risk factors
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-α, TGF-β and MIP-1α 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.