Brain death (BD) donor cytokinemia was associated with decreased organ recovery and worse post transplant outcomes before routine steroid use. Because steroids decrease cytokinemia in BD donors we questioned whether cytokinemia is associated with donor and recipient renal function in the steroid era.

Methods: Venous blood was collected 1-3 hours before organ recovery from 97 BD donors (2/2009-9/2012). All received IV methylprednisolone q8 hours from BD to organ recovery. Samples were immediately spun, aliquoted, and stored at -80°C until assayed. Using each aliquot once a Multiplex Immunoassay measured levels (pg/mL) of tumor necrosis factor alpha (TNF-Α), interleukins (IL)-1Β, 6, 8, 10 and monocyte chemotactic protein-1 (MCP-1). Donor information was obtained from the donor hospital record. Information was obtained on 132/148 kidney recipients from the recipient centers. Continuous data are presented as medians (interquartile ranges). Correlation matrices and multivariate linear regression analyses were performed with SPSS-19. Donor terminal creatinine (TCr) and creatinine clearance (TCrCl), recipient creatinine reduction ratio at day 2 (CRR2) and estimated GFR at 6 and 12 months (eGFR6, eGFR12) were outcome variables. Cytokines functioned as both input and outcome variables.

Results: Donors were predominantly male (59%), Caucasian (68%), aged 50 years (35, 57), and 51% were SCD. Recipients were 50 years old (40, 59) and 65% diabetic. HLA-mismatches were 5 (4, 6) and cold ischemia 14.7 (10, 20) hours. Cytokine levels are below:

Of donor characteristics, BMI correlated inversely with IL-8 (p<0.05). All cytokines except for IL-10 and IL-1Β correlated directly with TCr and inversely with TCrCl (p<0.05). In multivariate analyses, donor age, hypertension and IL-8 were significantly associated with TCr (R² 0.3, p<0.01). Similarly, donor sex and IL-8 were significantly associated with TCrCl (R² 0.3; p<0.05). In the recipient, cytokines were not associated with CRR2 or eGFR6. IL-10 was associated with eGFR12 in only univariate analysis (p<0.05).

Conclusions: 1) Despite routine steroid use, cytokinemia in BD donors is adversely associated with donor renal function. 2) Studies aimed at further reducing blood cytokine levels and whether such reductions would improve donor renal function are needed.

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