Inflammation in Brain-Dead Donor Organs and Therapeutic Approaches to It

The increasing number of patients on the waiting list for organ transplantation and organ shortage require the improvement of organ yield and graft quality from brain-dead donors. In addition to hemodynamic and metabolic disturbance, inflammatory responses might cause tissue damage and increase the risk of allograft dysfunction and rejection. Herein, we have summarized the evidence of inflammation in brain-dead organs and the therapeutic approaches to resolve it.

Some novel approaches, for instance, mesenchymal stem cell therapy, senolytics, calcineurin inhibitors, carbamylated erythropoietin, and 17β-estradiol have been tested in experimental models to improve the quality of brain-dead organs.

Elevated levels of proinflammatory cytokines, enhanced expression of adhesion molecules on endothelium, and leukocyte infiltration in brain-dead organs are associated with reduced graft quality. Accordingly, some treatments have been suggested including corticosteroid therapy, hemoadsorption, insulin therapy, CO inhalation, vasopressor administration, vagus nerve stimulation, and anti-thymocyte globulin.