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Direct Peritoneal Resuscitation Alters Leukocyte Infiltration in the Lung After Acute Brain Death

Weaver, Jessica L.*,†; Matheson, Paul J.; Matheson, Amy; Downard, Cynthia D.*; Garrison, Richard Neal*; Smith, Jason W.*

doi: 10.1097/SHK.0000000000001069
Basic Science Aspects
Editor's Choice

Background: Brain death is associated with significant lung injury and inflammation. This has been associated with worse long-term outcomes for transplanted lungs. Direct peritoneal resuscitation (DPR) reduces systemic inflammation in brain death and improves lung procurement rate. The effect of DPR on macrophage and neutrophil infiltration in the lungs is not known.

Methods: Male Sprague–Dawley rats had a 4F Fogarty catheter inserted into the skull and the balloon inflated until brain death was achieved. Rats were resuscitated with normal saline to maintain a mean arterial pressure of 80 mmHg (targeted intravenous fluid, TIVF) and DPR animals received an intraperitoneal injection of commercial peritoneal dialysis solution. Rats were sacrificed at 0, 2, 4, and 6 h after brain death. Protein levels were assessed using quantitative ELISA. Leukocytes were quantified using flow cytometry and immunohistochemistry.

Results: At all time points, DPR downregulated multiple inflammatory cytokines including IFN-γ, TNF-α, IL-1α, and IL-6. Adhesion molecules ICAM, E-selectin, and P-selectin were increased above sham at 4 and 6 h after brain death and reduced with DPR, whereas VCAM was reduced at 2 and 6 h. Infiltration of macrophages and neutrophils were trended downward at 6 h with DPR, though this difference was not statistically significant.

Conclusions: Animals that received TIVF alone had significant increases in inflammatory cytokines within the lung tissue, leading to adhesion molecule expression and ultimately leukocyte infiltration. Each stage of inflammation was affected by DPR. Using DPR in brain dead organ donors shows promise as a way to reduce lung injury and inflammation.

*University of Louisville Department of Surgery, Louisville, Kentucky

Robley Rex Veterans Affairs Medical Center, Louisville, Kentucky

Address reprint requests to Jessica L. Weaver, MD, PhD, 550 S Jackson St, ACB 2nd floor, Rm A2J19, Louisville, KY 40292. E-mail:

Received 2 July, 2017

Revised 25 July, 2017

Accepted 20 November, 2017

Presented as a poster at the 2017 Shock Society annual meeting in Fort Lauderdale, FL.

The authors report no conflicts of interest.

© 2018 by the Shock Society