Acute Endocrine Failure After Brain Death?

Gramm, H.-J.; Meinhold, H; Bickel, Ulrich; Zimmermann, Josef; Hammerstein, B von; Keller, Franco; Dennhardt, R.; Voigt, Katharina

doi:10.1097/00007890-199211000-00016

Cited by 179 publications

(109 citation statements)

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“…Organ harvesting is performed in individuals who have sustained massive, irreversible central nervous system injury (5) leading to unstable blood pressure, acute endocrine failure, derangement of coagulation, administration of pharmacological agents (e.g. steroids, catecholamines, vasopressin) and unphysiological volume replacement (6)(7)(8). Studies have shown a direct negative influence of BD on hepatic microcirculation (9).…”

Section: Introductionmentioning

confidence: 99%

Brain Death Impairs Pancreatic Microcirculation

Obermaier

Dobschuetz

Keck

et al. 2004

American Journal of Transplantation

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Brain death (BD) influences the quality of donor grafts in transplantation. To evaluate the impact of BD on pancreas grafts, we investigated the influence of BD on the microcirculation and histology of the pancreas in a rat model of explosive BD. A group of Wistar rats (n = = 7), rendered brain dead by inflating an intracranially inserted Fogarty catheter was compared with controls (CO) using intravital epifluorescence-microscopy over 4 h after BD induction; functional capillary density (FCD), leukocyte adherence (AL) in post-capillary venules, histology and pancreatic enzymes were investigated. Four hours after BD, FCD decreased (333 ± 11 vs. baseline 444 cm/cm 2 ± 5 SEM; p < 0.01) and showed lower values than CO (388 ± 9 p < 0.01). In BD, AL was increased (628 cells/mm 2 ± 110 SEM vs. baseline 123 ± 32, and vs. CO 180 ± 33; p < 0.001). BD caused increased histological damage (CO 1.6 scorepoints ± 0.7 SD vs. BD 8.3 ± 7.1; p < 0.05). Amylase was higher in BD (p < 0.05) but did not reach pathological values. We show for the first time that BD causes relevant changes in pancreatic microcirculation, histology and leukocyte endothelial interaction which might have a serious impact on the function of grafts. New strategies for preventing this damage are therefore highly desirable in order to improve the outcome of pancreas transplantation.

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Section: Introductionmentioning

confidence: 99%

Brain Death Impairs Pancreatic Microcirculation

Obermaier

Dobschuetz

Keck

et al. 2004

American Journal of Transplantation

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“…Múltiples cambios endocrinos han sido descritos en pacientes con muerte encefálica, pero su magnitud es variable y el significado clínico incierto 1,13,55,56 . El uso de hormonas exógenas (fundamentalmente corticoides y hormona tiroidea) no ha demostrado un beneficio claro en la sobrevida del injerto 57 .…”

Section: Manejo Endocrinológico Del Potencial Donante Cadáverunclassified

“…La diabetes insípida (DI) ocurre en más de 50% de los pacientes en muerte encefálica 14,16,56,59 , debido a que la irrigación hipofisiaria posterior depende del flujo de la carótida interna que se compromete como causa o consecuencia de la muerte cerebral, lo que lleva a una depleción precoz de hormona antidiurética (ADH) 55 . La falta de ADH impide que el túbulo renal reabsorba agua libre, traduciéndose en una poliuria con volúmenes de orina tan altos como 500 ml/ hora que, si la reposición no es adecuada, puede llevar a o perpetuar una situación de hipovolemia, hipotensión, hipernatremia y otras alteraciones hidroelectrolíticas 1,59 .…”

Section: Manejo Endocrinológico Del Potencial Donante Cadáverunclassified

Manejo del potencial donante cadáver

et al. 2014

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“…[55][56][57][58] Endocrine considerations Dysfunction of the posterior pituitary is common with resultant low to undetectable levels of vasopressin manifest clinically as DI, and occurring in up to 90% of adult and pediatric organ donors. 16,23,[59][60][61] In contrast, variable deficiency of hormones regulated by the anterior pituitary including T3, thyroxine (T4), adrenocorticotropic hormone, thyroid stimulating hormone, and human growth hormone have been described. Moreover, there has been inconsistent improvement in physiological parameters after replacement of these hormones in both animals and humans.…”

Section: Temporal Considerationsmentioning

confidence: 99%

“…Moreover, there has been inconsistent improvement in physiological parameters after replacement of these hormones in both animals and humans. 24,59,60,[62][63][64][65] Vasopressin produces its physiological effects through three different receptors: V1, V2, and V3. 66 The V1 receptors are located within blood vessels and mediate the vasopressor effect.…”

Section: Temporal Considerationsmentioning

confidence: 99%

Traitement médical pour optimaliser le potentiel de don d’organe : une revue documentaire

Kutsogiannis

Pagliarello

Doig

et al. 2006

Can J Anesth/J Can Anesth

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Purpose: Over the past two decades, the demand for donor organs continues to outpace the number of organs available for transplantation. Parallel with this has been a change in the demographics of organ donors with an increase in older donors and donors with marginal organs as a proportion of the total organ donor pool. Consequently, efforts have been made to improve the medical care delivered to potential organ donors to improve the conversion rate and graft survival of available organs. The purpose of this literature review is to provide updated recommendations for the contemporary management of organ donors after the neurological determination of death in order to maximize the probability of recipient graft survival. Sources:A comprehensive review of the literature obtained through searches of MEDLINE/PubMed, and personal reference files.Principal findings: Contemporary management of the organ donor after neurological determination of death includes therapies to prevent the detrimental effects of the autonomic storm, the use of invasive hemodynamic monitoring and aggressive respiratory therapy including therapeutic bronchoscopy in marginal heart and lung donors, and the use of hormonal therapy including vasopressin, corticosteroids, triiodothyronine or thyroxine, and insulin for the pituitary failure and inflammation seen in brain dead organ donors. The importance of normalizing donor physiology to optimize all available organs is stressed. Conclusion:Aggressive hemodynamic and respiratory management of solid organ donors, coupled with the use of hormonal therapy improves the rate of conversion and graft survival in solid organ recipients. Objectif

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Acute Endocrine Failure After Brain Death?

Cited by 179 publications

References 0 publications

Brain Death Impairs Pancreatic Microcirculation

Brain Death Impairs Pancreatic Microcirculation

Manejo del potencial donante cadáver

Traitement médical pour optimaliser le potentiel de don d’organe : une revue documentaire

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