Methylprednisolone therapy in deceased donors reduces inflammation in the donor liver and improves outcome after liver transplantation: a prospective randomized controlled trial

Ann Surg. 2008 Dec;248(6):1042-50. doi: 10.1097/SLA.0b013e318190e70c.


Objective: To investigate potential beneficial effects of donor treatment with methylprednisolone on organ function and outcome after liver transplantation.

Summary background data: It is proven experimentally and clinically that the brain death of the donor leads to increased levels of inflammatory cytokines and is followed by an intensified ischemia/reperfusion injury after organ transplantation. In experiments, donor treatment with steroids successfully diminished these effects and led to better organ function after transplantation.

Methods: To investigate whether methylprednisolone treatment of the deceased donor is applicable to attenuate brain death-associated damage in clinical liver transplantation we conducted a prospective randomized treatment-versus-control study in 100 deceased donors. Donor treatment (n = 50) consisted of 250 mg methylprednisolone at the time of consent for organ donation and a subsequent infusion of 100 mg/h until recovery of organs. A liver biopsy was taken immediately after laparotomy and blood samples were obtained after brain death diagnosis and before organ recovery. Cytokines were assessed by real-time reverse transcriptase-polymerase chain reaction. Soluble serum cytokines were measured by cytometric bead array system.

Results: After methylprednisolone treatment, steroid plasma levels were significantly higher (P < 0.05), and a significant decrease in soluble interleukins, monocyte chemotactic protein-1, interleukin-2, interleukin-6, tumor necrosis factor-alpha, and inducible protein-10 was observed. Methylprednisolone treatment resulted in a significant downregulation of intercellular adhesion molecule-1, tumor necrosis factor-alpha, major histocompatibility complex class II, Fas-ligand, inducible protein-10, and CD68 intragraft mRNA expression. Significantly ameliorated ischemia/reperfusion injury in the posttransplant course was accompanied by a decreased incidence of acute rejection.

Conclusions: Our present study verifies the protective effect of methylprednisolone treatment in deceased donor liver transplantation, suggesting it as a potential therapeutical approach.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Anti-Inflammatory Agents / administration & dosage*
  • Brain Death / physiopathology
  • Chemokine CCL2 / blood
  • Female
  • Humans
  • Inflammation / epidemiology
  • Inflammation / prevention & control
  • Interleukin-2 / blood
  • Interleukin-2 Receptor alpha Subunit / blood
  • Interleukin-6 / blood
  • Interleukins / blood
  • Liver / immunology
  • Liver Transplantation / adverse effects
  • Liver Transplantation / immunology*
  • Male
  • Methylprednisolone / administration & dosage*
  • Middle Aged
  • Postoperative Period
  • Prospective Studies
  • Reperfusion Injury / epidemiology
  • Reperfusion Injury / immunology
  • Reperfusion Injury / prevention & control*
  • Reverse Transcriptase Polymerase Chain Reaction
  • Tissue Donors
  • Treatment Outcome
  • Tumor Necrosis Factor-alpha / blood


  • Anti-Inflammatory Agents
  • Chemokine CCL2
  • Interleukin-2
  • Interleukin-2 Receptor alpha Subunit
  • Interleukin-6
  • Interleukins
  • Tumor Necrosis Factor-alpha
  • Methylprednisolone