| Using the kidney of brain-dead donor is a valuable method to alleviate the shortage of donor kidney. Between using the organ of brain-dead donor and LRD or LURD to transplant there is no difference in the field of surgical technology and method of therapy, but transplantation of both LRD- and LURD-kidneys were significantly better than transplantation of BDD kidneys in short- and long-term result. Why. Although transplantation of LURD is not superior in the genetic background compared with transplantation of BDD, why it is better than the latter. It suggest that bran death is an important reason.Objective: To investigate the change of renal morphology in the brain-dead state. To investigate the change of serum inflammatory mediators and the role of it in the hepatic injury of brain-dead Ba-Ma mini pigs.Materials and MethodsEleven Ba-Ma mini pigs were randomized into 2 groups: brain-dead group (group B, n=5), and control group (group C, n=5). Group B was established brain-dead model by increasing intracranial pressure in a modified, slow and intermittent way, and maintained brain-dead state for 24h by respiration and circulation support. The criteria for brain death were as following: a) deep coma; b) papillary reflex and corneal reflex disappear; c) spontaneous respirations cease, and PaO2 and saturation oxygen are maintained by a respirator; d) EEG is static; e) atropine test is negative; f) after 12h, the conditions that meet the first 5 criteria are reaffirmed. When the mean artery pressure (MAP) ≥ 60mm Hg, saturation oxygen ≥95%, PaO2≥ 100mm Hg, body temperature≥35℃, central venous pressure ≤1012mm Hg, and hemodynamic was stable, the brain-dead models were considered suitable as the brain-dead donor, the parameters( such as EEG) for judging brain death in group B were recorded. The serum TNF- α , IL-1 β, and IL-6 were determined at 3, 6 12,18, and 24h afterthe initial confirmation of brain death. Renal tissues were taken at 6, 12, and 24h. The alterations of Renal tissues was observed. The microstructure of Renal tissues was observed under electron microscope at 12 and 24h after the initial brain death. The brain-dead models were executed and dissected after the experiment, and the general alterations of brain tissues were observed.Results(1) Maintenance of brain-dead models: living signs of both group B met the requirements of brain-dead donors. The state of brain death was maintained for 24h for group B. At 24 and 48h, animals in group B developed "cardiac and pulmonary death" after disconnecting the respirator and cease of infusion. Cerebral hernia was formed in group B Animals in group C had not the above changes. (2) Inflammatory mediators: IL-1P, IL-6, and TNF- a for brain-dead group began to increase at 3h after brain death. At 3, 6, 12, 18, and 24h, IL-1P for the brain-dead group were 8.26±0.21, 9.17±0.08,10.30±0.11,12.53±0.35, and 16.37±0.16 pg/ml, and those for control group were 5.91±0.17, 5.91±0.10, 6.06+0.12, 6.08±0.12, and 6.10±0.15 pg/ml; IL-6 for the brain-dead group were 29.50±1.92, 37.92+1.69, 46.32±1.70,56.62±1.95, and 66.68±2.11 pg/ml, and those for control group were 17.35±0.59, 17.99±0.83, 17.77±1.05, and 17.62+0.67 pg/ml; TNF- a for the brain-dead group were 19.45±0.16, 21.76+0.25, 24.31±0.20, 27.65±0.27, and 31.35+0.16 pg/ml, and those for the control group were 14.94±0.36, 15.03±0.49, 14.71±0.46, 14.66±0.31, and 14.64+0.63 pg/ml. At each time point, IL-13, IL-6, and TNF- a for brain-dead group were all higher than those for control group (P<0.05); (3) Under light microscope, within 12h after the initial brain-death, there were slight renal proximal convoluted tubule cell edema, afterwards. Under election microscope, at 12h, mitochondrion mildly swelled; and at 24h, cytoplasm edema, mitochondrion swelling, crista disappearance, no obvious morphological injury was observed under light microscope and election microscope.Conclusion1 Brain death may evoke Ba-Ma mini renal morphological injury, moreover the injury is more obvious with the maintained state was prolonged.2 The levels of serum inflammatory mediators increase in the brain-dead Ba-Ma mini pigs. These serum inflammatory mediators may be involved in renal injury...
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