What the study found
Higher levels of circulating TNFα, a signaling protein involved in inflammation, in deceased donors were associated with worse kidney graft function and lower graft survival after transplantation. The association was seen after brain death donation but not after circulatory death donation.
Why the authors say this matters
The authors conclude that monitoring plasma inflammation during donor management may provide a window to assess and intervene to improve optimization and quality of deceased donor organs. They suggest this could help identify donor kidney injury before transplantation.
What the researchers tested
The researchers measured TNFα and its receptors TNFR1 and TNFR2 in 1,018 longitudinal plasma samples collected during donor management from 596 deceased and 34 living donors across multiple centers in the U.K. They also compared plasma findings with paired kidney biopsy samples and tested effects in vitro using human podocytes, specialized kidney cells.
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 replicated in a validation cohort and remained after adjustment for donor and recipient covariates; they were found in donations after brain death, but not in donations after circulatory death. In paired samples, higher plasma TNFα correlated with increased expression of kidney injury markers, and in vitro exposure of human podocytes to TNFα donor plasma produced TNFR1 signaling-driven injury profiles that were reduced by infliximab.
What to keep in mind
The abstract does not describe detailed study limitations beyond the observed differences between donation after brain death and donation after circulatory death. The findings are based on donor plasma measurements, paired biopsy analysis, and cell experiments, so the summary provided here is limited to those reported data.
Key points
- Higher donor TNFα was associated with worse kidney graft function and survival after transplantation.
- The association was reported for donations after brain death, but not after circulatory death.
- The findings were replicated in a validation cohort and held after covariate adjustment.
- Higher TNFα correlated with increased kidney injury markers in paired donor biopsy samples.
- In vitro, TNFα donor plasma triggered TNFR1 signaling-driven injury profiles in human podocytes, and infliximab reduced that response.
Disclosure
- Research title:
- High donor TNFα is linked to poorer 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:
- Laiko General Hospital of Athens, National and Kapodistrian University of Athens, NHS Blood and Transplant, NHS Blood and Transplant, NHS Blood and Transplant, Oxford University Hospitals NHS Trust, University of Oxford, University of Oxford, University of Oxford
- Publication date:
- 2026-02-04
- OpenAlex record:
- View
Get the weekly research newsletter
Stay current with scholarly research without reading academic papers — one filtered digest, every Friday.