Among brain-dead organ donors, older age donors contribute fewer organs for transplantation, and increased donor interleukin-6 level before organ procurement is associated with lower recipient six-month hospital-free survival.
Objective-Brain death induces dramatic changes in hemodynamics. Ischemic injury and inflammation resulting from inadequate resuscitation might influence organ yield for transplantation. Using functional hemodynamic monitoring in brain-dead organ donors, we test the hypothesis that donor preload (fluid) responsiveness is associated with increased inflammatory response and lower organ yield for transplantation. Design-Prospective, observational, pilot study.Setting-A large intensive care unit of a university hospital in the United States. Patients-Twenty-one brain-dead organ donors between July 2006 and April 2007. Interventions-None.* See also p. 2480. NIH Public Access Author ManuscriptCrit Care Med. Author manuscript; available in PMC 2010 May 5. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptMeasurements and Main Results-Following declaration of brain death, we collected data on donor demographics, mechanism of brain death, and number of organs procured and transplanted. Functional hemodynamics were monitored using pulse contour analysis technique. Plasma tumor necrosis factor, interleukin-6, and interleukin-10 concentrations were measured at study enrollment, after 4 hrs, and immediately before organ procurement for transplantation. Preload responsiveness (pulse pressure variation >13%) was observed in 48% of donors (mean ± SD pulse pressure variation, 19.2% ± 4.8%). Plasma interleukin-6 and tumor necrosis factor concentrations at study enrollment were greater in preload responsive donors: mean concentrations of interleukin-6 in preload responsive vs. unresponsive donors were 5420 ± 9102 vs. 378 ± 631 pg/mL (p = .009), and mean concentrations of tumor necrosis factor were 60.5 ± 103.6 vs. 15.7 ± 10.1 pg/mL (p = .048). Preload responsive compared with unresponsive donors had significantly increased interleukin-6 (p = .013) and tumor necrosis factor (p = .044) concentrations over time.Fewer organs were transplanted from preload responsive donors: mean organs transplanted from preload responsive vs. unresponsive donors were 1.8 ± 0.9 vs. 3.7 ± 2.5 (p = .034). In multivariable regression, older donor age (p = .028) and increased plasma interleukin-6 concentration (p = .035) were significantly associated with lower number of organs transplanted. Hemodynamic instability in potential organ donors is caused by several factors, such as autonomic dysfunction, hypovolemia, cardiac dysfunction, release of vasoactive inflammatory molecules, and secondary adrenal insufficiency (5), and may result in ischemia and reperfusion injury leading to organ dysfunction and loss (6). Hemodynamic instability can lead to increased inflammation and cardiac ischemia, which in turn can result in further hemodynamic instability, producing a vicious cycle (7-9). Therefore, optimal donor resuscitation may salvage many borderline organs and is critical to improve the number and quality of organs for transplantation (10). However, little is known about organ donor resuscitation practices because many donors ...
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