Donor brain death predisposes human kidney grafts to a proinflammatory reaction after transplantation.

Abstract

Donor brain death has profound effects on post-transplantation graft function and survival. We hypothesized that changes initiated in the donor influence the graft's response to ischemia and reperfusion. In this study, human brain dead donor kidney grafts were compared to living and cardiac dead donor kidney grafts. Pretransplant biopsies of brain dead donor kidneys contained notably more infiltrating T lymphocytes and macrophages. To assess whether the different donor conditions result in a different response to reperfusion, local cytokine release from the reperfused kidney was studied by measurement of paired arterial and renal venous blood samples. Reperfusion of kidneys from brain dead donors was associated with the instantaneous release of inflammatory cytokines, such as G-CSF, IL-6, IL-9, IL-16 and MCP-1. In contrast, kidneys from living and cardiac dead donors showed a more modest cytokine response with release of IL-6 and small amounts of MCP-1. In conclusion, this study shows that donor brain death initiates an inflammatory state of the graft with T lymphocyte and macrophage infiltration and massive inflammatory cytokine release upon reperfusion. These observations suggest that brain dead donors require a novel approach for donor pretreatment aimed at preventing this inflammatory response to increase graft survival.

• Authors: D K de Vries, J H N Lindeman, J Ringers, M E J Reinders, T J Rabelink, A F M Schaapherder
• Journal: American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons (Am J Transplant) Vol. 11 Issue 5 Pg. 1064-70 (May 2011) ISSN: 1600-6143 [Electronic] United States
• PMID: 21449948 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: ©2011 The Authors Journal compilation©2011 The American Society of Transplantation and the American Society of Transplant Surgeons.

Chemical References

• CCL2 protein, human
• Chemokine CCL2
• Interleukin-16
• Interleukin-6
• Interleukin-9
• Granulocyte Colony-Stimulating Factor

Topics

• Adult
• Aged
• Brain Death (physiopathology)
• Chemokine CCL2 (metabolism)
• Female
• Graft Survival
• Granulocyte Colony-Stimulating Factor (metabolism)
• Humans
• Inflammation (etiology, pathology)
• Interleukin-16 (metabolism)
• Interleukin-6 (metabolism)
• Interleukin-9 (metabolism)
• Kidney (immunology, physiopathology)
• Kidney Transplantation (adverse effects, methods)
• Macrophages (cytology)
• Male
• Middle Aged
• Reperfusion
• T-Lymphocytes (immunology)