Effects of brain death and hemodynamic status on function and immunologic activation of the potential donor liver in the rat.
OBJECTIVE
To assess the effect on the function and immunologic status of potential donor livers of the duration of brain death combined with the presence and absence of hemodynamic instability in the donor.


BACKGROUND
Brain death, regarded as a given condition in organ transplantation, could have significant effects on the donor organ quality.


METHODS
Brain death was induced in Wistar rats. Short or long periods of brain death in the presence or absence of hemodynamic instability were applied. Sham-operated rats served as controls. Organ function was studied by monitoring standard serum parameters. The inflammatory status of the liver was assessed by determining the immediate early gene products, the expression of cell adhesion molecules, and the influx of leukocytes in the liver.


RESULTS
Progressive organ dysfunction was most pronounced in hemodynamically unstable brain-dead donors. Irrespective of hemodynamic status, a progressive inflammatory activation could be observed in brain-dead rats compared with controls.


CONCLUSIONS
Brain death causes progressive liver dysfunction, which is made worse by the coexistence of hemodynamic instability. Further, brain death activates the inflammatory status of the potential donor liver, irrespective of the presence of hypotension. The changes observed may predispose the graft to additional damage from ischemia and reperfusion in the transplant procedure.
van Der Hoeven
J A
JA
Departments of Surgery, Biological Psychiatry, and Clinical Immunology, Groningen University Hospital, Groningen, The Netherlands. j.a.b.van.der.hoeven@chir.azg.nl
Ter Horst
G J
GJ
Molema
G
G
de Vos
P
P
Girbes
A R
AR
Postema
F
F
Freund
R L
RL
Wiersema
J
J
van Schilfgaarde
R
R
Ploeg
R J
RJ
D000818:Animals; D001774:Blood Chemical Analysis; D001926:Brain Death / Q000503:physiopathology*; D015815:Cell Adhesion Molecules / Q000378:metabolism; D017781:Genes, Immediate-Early / Q000235:genetics; D006439:Hemodynamics; D007022:Hypotension / Q000503:physiopathology; D007150:Immunohistochemistry; D007962:Leukocytes / Q000502:physiology; D008099:Liver / Q000276:immunology / Q000503:physiopathology* / Q000601:surgery; D016031:Liver Transplantation / Q000502:physiology; D008297:Male; D051381:Rats; D017208:Rats, Wistar; D018709:Statistics, Nonparametric; D014019:Tissue Donors
D015815:Cell Adhesion Molecules