Abstract
Background: Brain death is a major stress that is associated with a massive inflammatory response
and systemic hyperglycemia. Severe inflammation leads to increased graft immunogenicity
and risk of graft dysfunction; while acute hyperglycemia aggravates the inflammatory
response and increases the risk of morbidity and mortality. Insulin therapy not only
controls hyperglycemia but also suppresses inflammation. The present study is to investigate
the anti-inflammatory properties and the normoglycemia maintenance of high dose insulin
on brain dead organ donors.
Design: 15 brain dead organ donors were divided into 2 groups, insulin treated (n=6) and
controls (n=9). Insulin was provided for a minimum of 6 h using the hyperinsulinemic
normoglycemic clamp technique. The changes of serum cytokines, including IL-6, IL-10,
IL-1β, IL-8, TNFα, TGFα and MCP-1, were measured by suspension bead array immunoassay
and glucose by a glucose monitor.
Results: Compared to controls, insulin treated donors had a significant lower blood glucose
4.8 (4–6.9) vs. 9 (5.6–11.7) mmol/L, p<0.01); the net decreases of pro-inflammatory
cytokines, such as IL-6 and MCP-1, and the net increase of anti-inflammatory cytokine,
such as IL-10, reached significant level in insulin treated donors compared with those
in controls.
Conclusion: High dose insulin therapy decreases the concentrations of inflammatory cytokines
in brain dead donors and preserves normoglycemia. High dose of insulin may have anti-inflammatory
effects in brain dead organ donors and therefore, improve the quality of donor organs
and potentially improve outcomes.
Key words
hormones - adipocytokines - transplantation - brain dead donors - inflammation
