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Sandiumenge A, Bello I, Coll-Torres E, Gomez-Brey A, Franco-Jarava C, Miñambres E, Pérez-Redondo M, Mosteiro F, Sánchez-Moreno L, Crowley S, Fieira E, Suberviola B, Mazo CA, Agustí A, Pont T. Systemic Inflammation Differences in Brain-vs. Circulatory-Dead Donors: Impact on Lung Transplant Recipients. Transpl Int 2024; 37:12512. [PMID: 38887494 PMCID: PMC11182341 DOI: 10.3389/ti.2024.12512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 05/17/2024] [Indexed: 06/20/2024]
Abstract
Brain death triggers a systemic inflammatory response. Whether systemic inflammation is different in lung donors after brain- (DBD) or circulatory-death (DCD) is unknown, but this may potentially increase the incidence of primary graft dysfunction (PGD) after lung transplantation. We compared the plasma levels of interleukin (IL)-6, IL-8, IL-10 and TNF-α in BDB and DCD and their respective recipients, as well as their relationship with PGD and mortality after LT. A prospective, observational, multicenter, comparative, cohort-nested study that included 40 DBD and 40 DCD lung donors matched and their respective recipients. Relevant clinical information and blood samples were collected before/during lung retrieval in donors and before/during/after (24, 48 and 72 h) LT in recipients. Incidence of PGD and short-term mortality after LT was recorded. Plasma levels of all determined cytokines were numerically higher in DBD than in DCD donors and reached statistical significance for IL-6, IL-10 and IL-8. In recipients with PGD the donor's plasma levels of TNF-α were higher. The post-operative mortality rate was very low and similar in both groups. DBD is associated with higher systemic inflammation than DCD donors, and higher TNF-α plasma levels in donors are associated with a higher incidence of PGD.
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Affiliation(s)
- Alberto Sandiumenge
- Donation and Trasplantation Program Coordination Unit, Vall d’Hebron, University Hospital, Cell, Tissue and Organ Donation and Trasplantation Resarch Group, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain
| | - Irene Bello
- Department of Thoracic Surgery, Respiratory Institute Hospital Clínic, Barcelona, Spain
- Institut d’Investigacions BIomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Aroa Gomez-Brey
- Donation and Trasplantation Program Coordination Unit, Vall d’Hebron, University Hospital, Cell, Tissue and Organ Donation and Trasplantation Resarch Group, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain
| | | | - Eduardo Miñambres
- Transplant Coordination Unit and Department of Intensive Care, University Hospital Marqués de Valdecilla-IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - Marina Pérez-Redondo
- Departament of Critical Care, Department of Donor and Transplant Coordinator, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain
| | - Fernando Mosteiro
- Departament of Critical Care, Department of Donor and Transplant Coordinator, A Coruña University Hospital, A Coruña, Spain
| | - Laura Sánchez-Moreno
- Department of Thoracic Surgery, University Hospital Marqués de Valdecilla-IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - Silvana Crowley
- Department of Thoracic Surgery and Lung Trasplantation, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain
| | - Eva Fieira
- Department of Thoracic Surgery and Lung Trasplantation, A Coruña University Hospital, A Coruña, Spain
| | - Borja Suberviola
- Transplant Coordination Unit and Department of Intensive Care, University Hospital Marqués de Valdecilla-IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - Cristopher Alan Mazo
- Donation and Trasplantation Program Coordination Unit, Vall d’Hebron, University Hospital, Cell, Tissue and Organ Donation and Trasplantation Resarch Group, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain
| | - Alvar Agustí
- Institut d’Investigacions BIomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Pneumology, Respiratory Institute, Barcelona, Spain
- Cátedra de Salut Respiratoria, Universidad de Barcelona, Barcelona, Spain
- CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Teresa Pont
- Donation and Trasplantation Program Coordination Unit, Vall d’Hebron, University Hospital, Cell, Tissue and Organ Donation and Trasplantation Resarch Group, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain
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Wong A, Liu M. Inflammatory responses in lungs from donation after brain death: Mechanisms and potential therapeutic targets. J Heart Lung Transplant 2021; 40:890-896. [PMID: 34167864 DOI: 10.1016/j.healun.2021.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 01/16/2023] Open
Abstract
The vast majority of lungs used in clinical transplantation are donated after brain death (DBD). The utilization of DBD lungs is low due to brain death-induced lung injury. Moreover, inflammatory responses in DBD lungs used for transplantation contribute to ischemia-reperfusion injury and primary graft dysfunction. Work from human observational studies has demonstrated overexpression of cytokines, activation of endothelial cells, and cell death in DBD lungs, are associated with the activation of signaling pathways. Animal models have characterized the pulmonary injury induced by brain death and identified potential strategies to improve donor management. Interestingly, transcriptomic studies comparing DBD and donated after circulatory death (DCD) lungs have found that inflammatory responses are elevated in DBD lungs, while cell death pathways are elevated in DCD lungs. Development of the ex vivo lung perfusion technique, has made it possible to assess donor lungs using inflammation and cell death biomarkers. In the future, identification of potential therapeutic targets and development of novel treatments strategies may allow for lung repair during EVLP prior to transplantation.
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Affiliation(s)
- Aaron Wong
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada. https://twitter.com/aaronkkwong
| | - Mingyao Liu
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada; Latner Thoracic Surgical Research Laboratories, Toronto General Hospital Research Institute, University Health Network, Toronto, Canada; Departments of Surgery, Medicine and Physiology, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada.
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