Risikofaktor Hirntod — Einflüsse der Spendervorbehandlung auf die Funktion nach experimenteller Nierentransplantation

Abstract

Introduction: Kidneys transplanted from living donors perform consistently better than those from cadaver sources. We have recently demonstrated that donor BD produces inflammatory changes in peripheral organs within hours, amplifies coincident I/R injury and accelerates acute and chronic rejection. The present study assesses the influence of alternative strategies on the early behavior of kidneys after transplantion into unmodified hosts. Methods: A standardized rat model of BD was used. Donors were treated immediately after induction of BD either with i.v. steroids which block inflammatory cytokine release or with a soluble selectin glycoprotein ligand, sPSGL, which blocks initial selectin mediated cellular adhesion. Untreated BD-donors served as controls. Kidney grafts were examined serially up to 10 days by morphology, immunohistology and RT-PCR. Results: Overall survival of unmodified recipients of kidneys from BD donors was significantly reduced vs. living donors (p < 0.01). Animals with organs from BD donors which had received steroids or sPSGL survived significantly longer than those from untreated BD donors (p < 0.01). The intensity of I/R injury and of acute rejection were reduced. Cellular infiltration and transcription of mRNA of representative proinflammatory mediators were diminished (p < 0.05). Conclusions: Treatment of organ donors at the time of BD markedly improves organ quality after kidney transplantation, upgrading it to that from a living donor.