Organs from living donors seem to have a better graft function after transplantation compared to organs from brain dead and non-heart beating organ donors. We hypothesized that brain death might impair the energy status of organs and therefore systematically evaluated high energy phosphate content in organs from living, brain dead and from non-heart-beating donors in a pig model In 6 pigs brain death was induced under general anaesthesia by inflating a balloon in the epidural space. 10 hours after confirmation of brain death organs were retrieved. In 6 animals cardiac arrest was induced using 9 V direct current and mechanical and medical reanimation was performed after 10 min of ventricular fibrillation without cardiac output for 30 min. In 6 pigs organs were explanted without induction of brain death. Tissue was harvested before perfusion, after perfusion and after cold ischemia. Xanthine, hypoxanthine, adenosine-monophosphate, adenosine-diphosphate and adenosine-triphosphate were measured using high-performance liquid chromatographie. Energy charge and ATP/ADP ratio were calculated. Overall, after ischemia no difference in energy status of organs was observed between the different donor types. In all organs an increase in hypoxanthine levels and a decrease of high energy phosphate content was observed during perfusion and ischemia, irrespective of the donor type. In conclusion our hypothesis that brain death or cardiac arrest significantly impairs the energy status of donor organs did not hold true. Therefore the negative impact of brain death or cardiac arrest on graft function can not be attributed to changes in energy status.

Introduction. Due to the lack of human donors, several strategies have sought to expand the organ pool. Efforts to characterize donation after cardiac death (DCD) have included studies of cell viability, histological and immunohistochemical changes, and oxidative stress, which is known to negatively impact graft survival. A large animal model would be useful for these inquiries. Therefore, we sought to establish a DCD animal model in pigs.Methods. We simulated non heart-beating donation Maastricht II and III conditions in 24 pigs. Cardiac fibrillation was induced using 9-V direct current. After various times of ventricular fibrillation (1-10 minutes) with no mechanical and/or medical treatment to achieve cardiac output, reanimation was performed for 30 minutes prior to multiorgan donation. Then, a neurological status, was performed. Blood samples were obtained at defined times tissue samples were stored in liquid nitrogen and subsequently embedded in paraffin and subjected to further analysis.Results. We established a DCD pig model in our laboratory by inducing cardiac fibrillation. Up to now, only DCD donation according to the Maastricht criteria II and III has been performed, but establishing all Maastricht criteria of DCDs seems to be feasible.Conclusion. A DCD model in pigs enables us to characterize organ quality more precisely as well as evaluate amelioration of storage conditions and donor treatments in a large-animal model.

Albumin binds and detoxifies endotoxin in healthy people. Oxidative stress leads to protein oxidation and thus to impaired binding properties of albumin. This, in combination with increased gut permeability, leads to appearance of endotoxin in the systemic circulation and further to impaired organ function. We hypothesise that these processes occur in serum of brain-dead organ donors.

BACKGROUND: Pancreatic islet transplantation is a promising option for the treatment of diabetic patients; xenotransplantation of porcine islet cells would be a possibility to overcome the shortage of donor organs. Usually the donor pancreas is preserved with University of Wisconsin (UW) solution. A large number of reports have shown that the two-layer method (TLM), which employs oxygenated perfluorochemical and UW solution, is superior to simple cold storage. However, the extensive use of TLM is cost intensive and there is evidence that TLM only oxygenates small parts of the organ preserved. Another possibility to increase the oxygen supply during organ preservation would be the use of hyperbaric oxygenation (HBO) which increases the oxygen tension in fluids. The aim of this study was to evaluate the effect of pre-oxygenation of different preservation solutions on organ quality in terms of high energy phosphate levels as well as the occurrence of apoptosis and the induction of heat shock proteins and nitrosative stress induced cell death in porcine pancreatic tissue. METHODS: Porcine pancreatic tissue was preserved in different preservation solutions with or without pre-oxygenation for 6 hours of cold ischemic time (CIT). Then, tissue specimens were harvested and high energy phosphate levels were determined by HPLC. Moreover, immunohistochemistry was performed in order to detect occurrence of apoptosis, heat shock protein 70 (HSP70) as well as nitrosative stress induced cell death. RESULTS: Organs stored in pre-oxygenated UW solution showed best results in terms of high energy phosphate levels; apoptotic cells per islet as well as HSP70 positivity were significantly less when compared to simple UW storage and all other organ preservation solutions with or without pre-oxygenation. CONCLUSIONS: Pre-oxygenation of UW solution is a simple and promising method to improve islet cell quality after cold organ storage. However, further in vitro experiments have to be performed in order to confirm these findings.

Sereinigg, M.1; Stiegler, P.1; Schaffellner, S.1; Iberer, F.1; Kniepeiss, D.1; Valentin, T.2; Schweiger, M.1; Wagner, D.1; Puntschart, A.1; Krause, R.2; Tscheliessnigg, K.1 Author Information