Targeting inflammatory responses in the brain dead donor

Brain dead donors are the most common source for renal transplantation as the best therapy to treat end-stage kidney disease. Brain death (BD) is a complex pathological process, causing an inflammatory response which results in inferior graft function. Our group found prednisolone administration before BD, instead of after BD reduced renal inflammation. Unfortunately, neutralizing IL-6 or TNF-a, both central and pleiotropic inflammatory cytokines prior to BD did not improve renal function as we expected. We speculate that IL-6 and TNF-a possess both pro- and anti-inflammatory effect, meanwhile they have relatively independent signaling transduction pathway mediating the inflammatory response, even though they are overlapped and interacted. Therefore, the best way could be selective blockage of the detrimental feature while maintaining some beneficial function intact. In the future, focus will be on selective targeting and induction immunosuppressive therapy to maximize the yield of donor organs and improve receipt outcome.