title: Pathological characteristics of liver allografts from donation after brain death followed by cardiac death in pigs.
abstract: Donation after brain death followed by circulatory death (DBCD) is a unique practice in China. The aim of this study was to define the pathologic characteristics of DBCD liver allografts in a porcine model. Fifteen male pigs (25-30 kg) were allocated randomly into donation after brain death (DBD), donation after circulatory death (DCD) and DBCD groups. Brain death was induced by augmenting intracranial pressure. Circulatory death was induced by withdrawal of life support in DBCD group and by venous injection of 40 mL 10% potassium chloride in DCD group. The donor livers were perfused in situ and kept in cold storage for 4 h. Liver tissue and common bile duct samples were collected for hematoxylin and eosin staining, TUNEL testing and electron microscopic examination. Spot necrosis was found in hepatic parenchyma of DBD and DBCD groups, while a large area of necrosis was shown in DCD group. The apoptosis rate of hepatocytes in DBD [(0.56±0.30)%] and DBCD [(0.50 ± 0.11)%] groups was much lower than that in DCD group [(3.78±0.33)%] (P<0.05). And there was no significant difference between DBD group and DBCD group (P>0.05)). The structures of bile duct were intact in both DBD and DBCD groups, while the biliary epithelium was totally damaged in DCD group. Under electron microscope, the DBD hepatocytes were characterized by intact cell membrane, well-organized endoplasmic reticulum, mild mitochondria edema and abundant glycogens. Broken cell membrane, mild inflammatory cell infiltration and sinusoidal epithelium edema, as well as reduced glycogen volume, were found in the DBCD hepatocytes. The DCD hepatocytes had more profound cell organelle injury and much less glycogen storage. In conclusion, the preservation injury of DBCD liver allografts is much less severe than that of un-controlled DCD, but more severe than that of DBD liver allografts under electron microscope, which might reflect post-transplant liver function to some extent.
authors.affiliation: Organ Transplant Center, Sun Yat-sen University, Guangzhou, 510080, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Ye
authors.affiliation: Organ Transplant Center, Sun Yat-sen University, Guangzhou, 510080, China.
authors.forename: Dong-Ping
authors.initials: DP
authors.lastname: Wang
authors.affiliation: Organ Transplant Center, Sun Yat-sen University, Guangzhou, 510080, China.
authors.forename: Chuan-Zhao
authors.initials: CZ
authors.lastname: Zhang
authors.affiliation: Laboratory of Surgery, Sun Yat-sen University, Guangzhou, 510080, China.
authors.forename: Long-Juan
authors.initials: LJ
authors.lastname: Zhang
authors.affiliation: Organ Transplant Center, Sun Yat-sen University, Guangzhou, 510080, China.
authors.forename: Hao-Chen
authors.initials: HC
authors.lastname: Wang
authors.affiliation: Organ Transplant Center, Sun Yat-sen University, Guangzhou, 510080, China.
authors.forename: Zhuo-Hui
authors.initials: ZH
authors.lastname: Li
authors.affiliation: Department of Anesthesiology, Sun Yat-sen University, Guangzhou, 510080, China.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Chen
authors.affiliation: Department of Anesthesiology, Sun Yat-sen University, Guangzhou, 510080, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Zhang
authors.affiliation: Surgical Intensive Care Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China.
authors.forename: Chang-Jie
authors.initials: CJ
authors.lastname: Cai
authors.affiliation: Organ Transplant Center, Sun Yat-sen University, Guangzhou, 510080, China.
authors.forename: Wei-Qiang
authors.initials: WQ
authors.lastname: Ju
authors.affiliation: Organ Transplant Center, Sun Yat-sen University, Guangzhou, 510080, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Ma
authors.affiliation: Organ Transplant Center, Sun Yat-sen University, Guangzhou, 510080, China. rockyucsf1981@126.com.
authors.forename: Zhi-Yong
authors.initials: ZY
authors.lastname: Guo
authors.affiliation: Organ Transplant Center, Sun Yat-sen University, Guangzhou, 510080, China. gdtrc@126.com.
authors.forename: Xiao-Shun
authors.initials: XS
authors.lastname: He
mesh_terms: D064591:Allografts; D000818:Animals; D017209:Apoptosis; D001926:Brain Death; D002681:China; D003643:Death; D006323:Heart Arrest; D022781:Hepatocytes / Q000473:pathology / Q000648:ultrastructure; D006801:Humans; D020287:In Situ Nick-End Labeling; D008099:Liver / Q000473:pathology / Q000648:ultrastructure; D016031:Liver Transplantation / Q000379:methods*; D008854:Microscopy, Electron; D009926:Organ Preservation / Q000379:methods*; D013552:Swine; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000379:methods*