Speed of Onset of Donor Brain Death Leads to Differences in Renal Function and Expression of Inflammatory and Oxidative Stress Markers in Rat Kidneys
1Abdominal Surgery, University Medical Center Groningen, Groningen, Netherlands
2Faculty of Medicine, University of Chile, Santiago, Chile
3Cardiothoracic Surgery, University Medical Center Groningen, Groningen, Netherlands.
Meeting: 2015 American Transplant Congress
Abstract number: A59
Keywords: Brain death, Donation, Kidney, Oxidant stress
Session Information
Date: Saturday, May 2, 2015
Session Name: Poster Session A: Donor Management: All Organs
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Exhibit Hall E
Introduction
Donor brain death (BD) is an independent risk factor for primary and delayed renal graft function. Furthermore, the speed of onset of brain death, traumatic (sudden) or hemorrhagic (gradual), influences graft function after transplantation. No explanation has been reported so far to explain the differential effect of cause of donor BD on renal graft function. This study was conducted to elucidate potential underlying processes initiated by either sudden or gradual brain injury leading to BD.
Material & Methods
Gradual- and sudden onset BD was induced in 64 mechanically ventilated male Fisher rats by inflating a 4.0F Fogarty catheter in the epidural space. Rats were observed for 0.5 h, 1 h, 2 h, or 4 h following BD induction. Tissue and serum from 8 non brain dead rats were used to obtain baseline values. Gradual onset BD was achieved by inflating the catheter at a speed of 0.015 ml/min until confirmation of BD by the increase in blood pressure (BP) due to the characteristic catecholamine storm. Sudden onset of brain death was achieved by inflating the catheter at 0.45 ml/min for 1 minute. BP was kept above 80 mmHg through the administration of plasma expanders or nor-epinephrine. Temperature, end tidal CO2, and oxygen saturation were regulated and kept at normal values.
Results
Gradual-onset BD led to a consistent drop in BP below 60 mm Hg during induction whereas sudden-onset BD led to a rise in BP above 200 mmHg. Sudden-onset BD rats required more inotropic support during the first hour of BD. Plasma creatinine values were significantly higher in gradual-onset BD rats at all time points. Gradual-onset of BD led to significant higher renal levels of, MDA, glutathione reductase activity, oxidized glutathione and mRNA expression of IL-6, HO-1, iNOS, and MnSOD after 4 h of BD.
Conclusion
Gradual-onset of BD leads to increased renal inflammation and oxidative stress compared to sudden-onset of BD. The hypotensive period during gradual-onset BD induction could be a possible explanation for these results.
To cite this abstract in AMA style:
Hoeksma D, Rebolledo R, Hottenrott M, Bodar Y, Leuvenink H. Speed of Onset of Donor Brain Death Leads to Differences in Renal Function and Expression of Inflammatory and Oxidative Stress Markers in Rat Kidneys [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/speed-of-onset-of-donor-brain-death-leads-to-differences-in-renal-function-and-expression-of-inflammatory-and-oxidative-stress-markers-in-rat-kidneys/. Accessed May 31, 2020.« Back to 2015 American Transplant Congress