What the study found
Higher levels of tumor necrosis factor alpha (TNFα, a protein involved in inflammation) in deceased donors were linked to worse kidney graft function and survival after transplant, especially in donations after brain death.
Why the authors say this matters
The authors conclude that monitoring plasma inflammation during donor management may offer a window to assess and intervene to improve the quality of deceased donor organs.
What the researchers tested
The researchers measured TNFα and its receptors TNFR1 and TNFR2 in 1,018 plasma samples from 596 deceased donors and 34 living donors across multiple UK centers. They also compared donor plasma with paired kidney biopsies and tested the effects of TNFα donor plasma on human podocytes in vitro, including the effect of infliximab.
What worked and what didn't
High donor plasma TNFα levels were associated with inferior graft function at 12 months and up to 60 months, and with reduced graft survival up to 96 months. These associations were seen in donations after brain death, not in donations after circulatory death, and they were replicated in a validation cohort and remained after adjustment for donor and recipient covariates. High TNFα also correlated with increased expression of injury markers in donor kidney tissue, and TNFα donor plasma caused TNFR1 signaling-driven injury profiles in podocytes that were ameliorated by infliximab.
What to keep in mind
The abstract does not describe detailed limitations beyond noting that the associations differed by type of deceased donation. The findings are based on observational associations and laboratory experiments reported in the abstract, so the summary cannot claim causation beyond what the authors state.
Key points
- High donor plasma TNFα was associated with poorer kidney graft function after transplant.
- The association extended to reduced graft survival for up to 96 months.
- The relationship was seen after brain death, but not after circulatory death.
- Donor TNFα levels correlated with kidney injury markers in paired biopsy samples.
- In vitro, TNFα donor plasma triggered TNFR1 signaling-driven injury in human podocytes, and infliximab reduced this response.
Disclosure
- Research title:
- Donor TNFα linked to worse kidney graft outcomes
- Authors:
- Sarah Fawaz, Ivan Grant Hartling, Ioannis Michelakis, Rebecca H. Vaughan, Rutger J. Ploeg, Edward Sharples, Philip D. Charles, Maria Kaisar
- Institutions:
- University of Oxford, National and Kapodistrian University of Athens, Laiko General Hospital of Athens, NHS Blood and Transplant, Oxford University Hospitals NHS Trust
- Publication date:
- 2026-02-01
- OpenAlex record:
- View
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