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 do nor livers of the duration of brain death combined with the presence and ab sence of hemodynamic instability in the donor. Summary Background Data 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 deat h 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 assesse d 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 unstab le brain-dead donors. Irrespective of hemodynamic status, a progressive inf lammatory activation could be observed in brain-dead rats compared with con trols. Conclusions Brain death causes progressive liver dysfunction, which is made worse by th e coexistence of hemodynamic instability. Further, brain death activates th e inflammatory status of the potential donor liver. irrespective of the pre sence of hypotension. The changes observed may predispose the graft to addi tional damage from ischemia and reperfusion in the transplant procedure.