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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 J+Transl+Med
2016 ; 14
(1
): 141
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Slow induction of brain death leads to decreased renal function and increased
hepatic apoptosis in rats
#MMPMID27193126
Rebolledo RA
; Hoeksma D
; Hottenrott CM
; Bodar YJ
; Ottens PJ
; Wiersema-Buist J
; Leuvenink HG
J Transl Med
2016[May]; 14
(1
): 141
PMID27193126
show ga
BACKGROUND: Donor brain death (BD) is an independent risk factor for graft
survival in recipients. While in some patients BD results from a fast increase in
intracranial pressure, usually associated with trauma, in others, intracranial
pressure increases more slowly. The speed of intracranial pressure increase may
be a possible risk factor for renal and hepatic graft dysfunction. This study
aims to assess the effect of speed of BD induction on renal and hepatic injury
markers. METHODS: BD induction was performed in 64 mechanically ventilated male
Fisher rats by inflating a 4.0F Fogarty catheter in the epidural space. Rats were
observed for 0.5, 1, 2 or 4 h following BD induction. Slow induction was achieved
by inflating the balloon-catheter at a speed of 0.015 ml/min until confirmation
of BD. Fast induction was achieved by inflating the balloon at 0.45 ml/min for
1 min. Plasma, kidney and liver tissue were collected for analysis. RESULTS: Slow
BD induction led to higher plasma creatinine at all time points compared to fast
induction. Furthermore, slow induction led to increased renal mRNA expression of
IL-6, and renal MDA values after 4 h of BD compared to fast induction. Hepatic
mRNA expression of TNF-?, Bax/Bcl-2, and protein expression of caspase-3 was
significantly higher due to slow induction after 4 h of BD compared to fast
induction. PMN infiltration was not different between fast and slow induction in
both renal and hepatic tissue. CONCLUSION: Slow induction of BD leads to poorer
renal function compared to fast induction. Renal inflammatory and oxidative
stress markers were increased. Liver function was not affected by speed of BD
induction but hepatic inflammatory and apoptosis markers increased significantly
due to slow induction compared to fast induction. These results provide initial
proof that speed of BD induction influences detrimental renal and hepatic
processes which could signify different donor management strategies for patients
progressing to BD at different speeds.