Sudden onset of brain death leads to better rat kidney function than gradual onset of brain death.
D. Hoeksma, C.M.V. Hottenrott, R. Rebolledo, Y. Bodar, H.G.D. Leuvenink
Location(s): Rondgang 1e verdieping
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Introduction. Donor brain death is an independent risk factor for primary and delayed renal graft dysfunction. Brain death (BD) leads to a cascade of events including hemodynamic instability and a systemic state of inflammation. In this study, we investigated the impact of mode of donor BD on BD related processes and how this influences kidney function and inflammation. Material & Methods. 72 male Fisher rats were subjected to either gradual or sudden onset of BD with a BD duration of 0.5, 1, 2 or 4 hrs. BD was induced by inflating a 4.0 Fogarty catheter in the epidural space. Gradual-onset BD was achieved by inflating the catheter at a speed of 1.6 ml/hr until confirmation of BD. Sudden onset of BD was achieved by delivering a fixed volume of 0.45 ml in 1 minute. Blood pressure was maintained within a range of 80-150 mmHg through the administration of plasma expanders and norepinephrine. Results. Hemodynamic patterns revealed no differences between the two models besides a decrease in blood pressure during the induction phase of gradual-onset BD. During this phase, blood pressure ranges between 40 and 80 mmHg for an average time period of 15 min. Donor management was comparable for both modes of BD except for the increased need of inotropic support in the first hour after sudden onset of BD. Plasma creatinine values were significantly increased (p < 0.03) at all time points in rats subjected to gradual-onset BD. Blood urea nitrogen in gradual-onset brain dead rats was significantly increased only at the 1 hr time point. Lipid peroxidation, indicative for oxidative stress, was significantly increased (p < 0.01) in kidneys of gradual-onset brain dead rats.
Conclusion. Mode of donor BD leads to hemodynamic differences during the induction period. Even though no hemodynamic differences were observed during the BD period, more inotropic support was needed in sudden-onset BD. Gradual-onset BD negatively affects renal function when compared to sudden-onset BD. Furthermore, gradual-onset BD significantly increases renal oxidative stress.