Does donor brain death influence acute vascular rejection in the kidney transplant?
BACKGROUND
There is increasing experimental evidence to suggest that donor brain death enhances susceptibility to early inflammatory responses such as acute rejection in the kidney transplant. The aim of the present study was to establish whether the injury induced or aggravated by donor brain death could exert an effect on recipient immunologic tolerance by comparing data from patients receiving a kidney from non-heart-beating donors (NHBD) or from brain-dead donors (BDD).


METHODS
We reviewed data corresponding to 372 renal transplants performed from January 1996 to May 2002. The data were stratified according to donor type as 197 (53%) brain-dead and 175 (47%) non-heart-beating donors, and the two groups were compared in terms of acute vascular rejection by Cox's regression analysis.


RESULTS
The rate of vascular rejection was 28% in the BDD group and 21.7% in the NHBD (P=0.10). The following predictive variables for acute vascular rejection were established: brain death [RR 1.77 (95% CI 1.06-3.18)], presence of delayed graft function [RR 3.33 (1.99-5.55)], previous transplant [RR 2.35 (1.34-4.13)], recipient age under 60 years [RR 1.86 (0.99-2.28)], female recipient [RR 1.50 (0.99-2.28)], cerebrovascular disease as cause of donor death [RR 1.72 (1.02-2.91)], and triple therapy as immunosuppressive treatment.


CONCLUSIONS
Donor brain death could be a risk factor for the development of vascular rejection in kidney recipients. This process could affect the quality of the graft and host alloresponsiveness. Delayed graft function in transplants from dead brain donors could be a reflection of severe autonomic storm, leading to a higher incidence of vascular rejection in these patients.
Sánchez-Fructuoso
Ana I
AI
Department of Nephrology, Hospital Clínico San Carlos, Facultad de Medicina, Universidad Complutense, Madrid, Spain. sanchezfruct@telefonica.net
Prats
Dolores
D
Marques
María
M
Blanco
Julia
J
Torrente
Jaime
J
Conesa
José
J
Rio
Francisco Del
FD
Núñez
Jose R
JR
Barrientos
Alberto
A
D000208:Acute Disease; D000328:Adult; D001926:Brain Death; D005260:Female; D006084:Graft Rejection / Q000401:mortality*; D006323:Heart Arrest; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D012307:Risk Factors; D014019:Tissue Donors