Activation of the heart by donor brain death accelerates acute rejection after transplantation.
BACKGROUND
Donor brain death upregulates expression of inflammatory mediators in the heart. It is hypothesized that these nonspecific changes trigger and amplify acute rejection in unmodified recipients compared with hearts from normal living donors. We examined the inflammatory and immunological consequences of gradual-onset donor brain death on cardiac allografts after transplantation.


RESULTS
Functioning hearts were engrafted from normotensive donors after 6 hours of ventilatory support. Hearts from brain-dead rats (Fisher, F344) were rejected significantly earlier (mean+/-SD, 9. 3+/-0.6 days) by their (Lewis) recipients than hearts from living donor controls (11.6+/-0.7 days, P=0.03). The inflammatory response of such organs was accelerated, with rapid expression of cytokines, chemokines, and adhesion molecules and brisk infiltration of associated leukocyte populations. Upregulation of major histocompatibility class II antigens increased organ immunogenicity. Acute rejection evolved in hearts from brain-dead donors more intensely and at a significantly faster rate than in controls.


CONCLUSIONS
Donor brain death is deleterious to transplanted hearts. The resultant upregulation of inflammatory factors provokes host immune mechanisms and accelerates the acute rejection process in unmodified hosts.
Wilhelm
M J
MJ
Surgical Research Laboratory, Harvard Medical School and the Department of Surgery, Brigham and Women's Hospital, Cambridge, Massachusetts, USA.
Pratschke
J
J
Beato
F
F
Taal
M
M
Kusaka
M
M
Hancock
W W
WW
Tilney
N L
NL
D000818:Animals; D001926:Brain Death / Q000276:immunology*; D018925:Chemokines / Q000096:biosynthesis / Q000276:immunology; D016207:Cytokines / Q000096:biosynthesis / Q000276:immunology; D004195:Disease Models, Animal; D006084:Graft Rejection / Q000276:immunology*; D016027:Heart Transplantation / Q000276:immunology*; D000949:Histocompatibility Antigens Class II / Q000276:immunology; D009206:Myocardium / Q000276:immunology*; D051381:Rats; D011916:Rats, Inbred F344; D014019:Tissue Donors; D014184:Transplantation, Homologous / Q000276:immunology; D015854:Up-Regulation
D018925:Chemokines; D016207:Cytokines; D000949:Histocompatibility Antigens Class II