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The hemodynamic mechanisms of lung injury and systemic inflammatory response following brain death in the transplant donor

Lookup NU author(s): Vassillios Avlonitis, Chris Wigfield, Emeritus Professor John Kirby, Professor John Dark


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Brain-dead donors are the major source of lungs for transplantation. Brain death is characterized by two hemodynamic phases. Initially, massive sympathetic discharge results in a hypertensive crisis. This is followed by neurogenic hypotension. Up-regulation of pro-inflammatory mediators occurs in all organs and lung injury develops; this can adversely affect graft function post-transplantation. The mechanisms of the systemic and lung inflammation are unknown. We hypothesized that the hemodynamic changes are responsible for these inflammatory phenomena. Brain death was induced by intra-cranial balloon inflation in rats. This resulted in hypertensive crisis, followed by hypotension. There was a significant increase in blood neutrophil CD11b/CD18 expression and pro-inflammatory cytokine levels in serum and bronchoalveolar lavage, compared with control animals. Rupture of the capillary-alveolar membrane was demonstrated by electron microscopy. Elimination of the hypertensive response by α-adrenergic antagonist pre-treatment prevented inflammatory lung injury, reduced the systemic inflammatory markers and preserved capillary-alveolar membrane integrity. Correction of the neurogenic hypotension with noradrenaline ameliorated the systemic inflammatory response and improved oxygenation. We conclude that the sympathetic discharge triggers systemic and lung inflammation, which can be further enhanced by neurogenic hypotension. Management of the brain-dead donor with early anti-inflammatory treatment and vasoconstrictors is warranted. Copyright © Blackwell Munksgaard 2005.

Publication metadata

Author(s): Avlonitis VS, Wigfield CH, Kirby JA, Dark JH

Publication type: Article

Publication status: Published

Journal: American Journal of Transplantation

Year: 2005

Volume: 5

Issue: 4 I

Pages: 684-693

Print publication date: 01/04/2005

ISSN (print): 1600-6135

ISSN (electronic): 1600-6143

Publisher: Wiley-Blackwell


DOI: 10.1111/j.1600-6143.2005.00755.x

PubMed id: 15760391


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