NIV Congres

Organs derived from deceased brain dead (DBD) donors show worse function and more acute rejection episodes than those from living donors (LD). Brain death induces a progressive inflammatory response in potential donor organs. Minor morphological renal damage is present in healthy potential donors. We hypothesize that pre-existent morphological renal damage is more prominent in kidneys from DBD donors compared to LD and might predict graft failure after kidney transplantation.

We used renal biopsies of 125 living and 73 DBD donors. Associations with donor characteristics and recipient outcome were determined. The degree of FGS, interstitial fibrosis (IF), intima thickness and vascular hyalinosis were scored. Sections were scored for macrophages, neutrophilic granulocytes and pre-fibrosis (α-SMA).

Vascular hyalinosis, FGS, macrophages and granulocytes are markedly increased in DBD compared to LD (p<0.05). Arterial intima thickness and IF are not significantly different between the donor types. The degree of FGS and IF are associated with donor age (ρ = 0.265, ρ = 0.315 resp; both p<0.01). IF correlates with diastolic blood pressure and effective renal plasma flow (ERPF) prior to donation (ρ = 0.144, ρ = -0.197 resp; both p<0.05). Macrophages and arterial intima thickness correlated univariate with delayed graft function (DGF) (Exp(B)=261.1 and Exp(B)=1.021 resp; both p<0.05). In multivariate analysis, 5 year graft survival was best predicted by neutrophilic granulocytes (p<0.05). Separately analyzed, 1 year graft survival in DBD donor is best predicted by IF (p<0.05) and in LD by the degree of arterial intima thickness. Five year graft survival in DBD donor is best predicted by IF and in LD by the degree of vascular hyalinosis.

Pre-existent renal damage is more prominent in kidneys of DBD donors than in kidneys from LD. Therefore, therapeutic interventions in the DBD donor could be a tool to reduce the inflammatory damage of the graft-to-be and thereby improve organ quality and graft survival.