Brain Death Effects on Catecholamine Levels and Subsequent Cardiac Damage Assessed in Organ Donors

López, Silvia Pérez; Otero, Jesús María Garagorri; Moreno, Natalia Vázquez; Augusto, D. Escudero; Menéndez, Francisco Álvarez; Astudillo, Aurora

doi:10.1016/j.healun.2009.04.021

Cited by 47 publications

(19 citation statements)

References 26 publications

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“…In acute evaluations of human BD, catecholamine levels were above normal values immediately after the BD event and remained higher after several hours, with increased inflammatory responses and apoptosis being observed in different organ samples (1,6,7). In a rodent model of heart transplantation, a longer duration of BD leads to increased leukocyte infiltration and expression of adhesion molecules on the endothelial cells of the transplanted graft, thereby resulting in accelerated acute rejection (8).…”

Section: Discussionmentioning

confidence: 95%

Paradoxical effects of brain death and associated trauma on rat mesenteric microcirculation: an intravital microscopic study

Simas¹,

Sannomiya²,

Cruz³

et al. 2012

Clinics

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OBJECTIVE:Experimental findings support clinical evidence that brain death impairs the viability of organs for transplantation, triggering hemodynamic, hormonal, and inflammatory responses. However, several of these events could be consequences of brain death–associated trauma. This study investigated microcirculatory alterations and systemic inflammatory markers in brain-dead rats and the influence of the associated trauma.METHOD:Brain death was induced using intracranial balloon inflation; sham-operated rats were trepanned only. After 30 or 180 min, the mesenteric microcirculation was observed using intravital microscopy. The expression of P-selectin and ICAM-1 on the endothelium was evaluated using immunohistochemistry. The serum cytokine, chemokine, and corticosterone levels were quantified using enzyme-linked immunosorbent assays. White blood cell counts were also determined.RESULTS:Brain death resulted in a decrease in the mesenteric perfusion to 30%, a 2.6-fold increase in the expression of ICAM-1 and leukocyte migration at the mesentery, a 70% reduction in the serum corticosterone level and pronounced leukopenia. Similar increases in the cytokine and chemokine levels were seen in the both the experimental and control animals.CONCLUSION:The data presented in this study suggest that brain death itself induces hypoperfusion in the mesenteric microcirculation that is associated with a pronounced reduction in the endogenous corticosterone level, thereby leading to increased local inflammation and organ dysfunction. These events are paradoxically associated with induced leukopenia after brain damage.

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Section: Discussionmentioning

confidence: 95%

Paradoxical effects of brain death and associated trauma on rat mesenteric microcirculation: an intravital microscopic study

Simas¹,

Sannomiya²,

Cruz³

et al. 2012

Clinics

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“…It is thought that impending brain death leads to a catecholamine surge from the stressed sympathetic neuroendocrine system that impairs function in a number of ways. This surge has been observed in human (18, 19) and animal (20-22) studies, and has been linked to poor hemodynamic stability and cardiac function (20), decreased coronary blood flow (23), cardiomyocyte damage (24), as well as increased troponin production and turnover (25). Whether troponin elevations and impaired function reflect irreversible cardiac damage in potential donors who suffer a non-cardiac arrest remains a point of much debate (3, 26-28).…”

Section: Discussionmentioning

confidence: 99%

Troponin I levels from donors accepted for pediatric heart transplantation do not predict recipient graft survival

Lin

Sullivan

Salam

et al. 2011

The Journal of Heart and Lung Transplantation

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Background Troponin I (TnI) is often obtained during evaluation of a potential transplant donor heart. It is unclear whether elevations in donor TnI levels predict adverse outcomes and should thus preclude acceptance of a donor heart. The aim of this study was to examine whether TnI levels from donors accepted for pediatric heart transplantation predict graft failure. Design/Methods De-identified data on heart transplants performed in recipients ≤ 21 years old between 4/07-4/09 was provided by the Organ Procurement and Transplantation Network. Donor TnI level and recipient outcomes including survival without re-transplantation (graft survival) were examined for statistical correlation. Results Overall graft survival in 839 heart transplants was 81% at 2 years. 657 donors had at least one TnI level recorded prior to transplant, with values ranging from 0-50 ng/ml (median 0.1). There was no correlation between TnI level and graft status (p=0.74). An ROC curve showed no association between TnI and graft status (AUC=0.51; p=0.98), and there was no difference in graft survival (p=0.60) among quartiles of TnI (<0.04, 0.04-<0.1, 0.1-<0.35, ≥0.35 ng/ml). 74 transplanted donors had a TnI ≥1; graft survival was not associated with TnI≥1 (80%) vs TnI<1(80%) at 2 years (p=0.93). TnI values were also not associated with post-transplant hospital length of stay (r=-0.06; p=0.10). Conclusions In donor hearts accepted for pediatric heart transplantation, pre-procurement TnI elevations are not associated with increased graft failure. Many heart donors have elevated TnI levels whose significance remain unclear and should therefore be considered in the context of other clinical information.

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“…1–3 Marked elevations in levels of catecholamines, interleukin 1, interleukin 6 (IL-6), tumor necrosis factor–α (TNF-α), and other cytokines or chemokines are well documented in humans after brain death 1,4–6 and are associated with reduced function and survival of transplanted organs. 7–9 …”

mentioning

confidence: 99%

Randomized Trial to Evaluate Nutritional Status and Absorption of Enteral Feeding after Brain Death

Hergenroeder

Ward

et al. 2013

Prog Transpl

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Context Catecholamines and inflammatory mediators, with elevated levels after brain death, are associated with reduced function and survival of transplanted organs. Enteral nutrition reduces tissue damage and may benefit organs. Objective To evaluate the effects of immunomodulating enteral nutrition in organ donors. Design Prospective, randomized, open-label study. Setting Intensive care unit. Patients Thirty-six brain-dead organ donors. Interventions Donors were randomized to receive enteral nutrition containing omega-3 polyunsaturated fatty acid, antioxidants, and glutamine or standard care (fasting). Donors received hormonal replacement therapy of corticosteroid, levothyroxine, dextrose, and insulin. Main Outcome Measures Gastrointestinal assimilation (measured by 13carbon-labeled uracil breath analysis), quantity of organs recovered, resting energy expenditure, urine level of urea nitrogen, and serum levels of albumin, prealbumin, interleukin 6, tumor necrosis factor-α, and C-reactive protein were evaluated. Results Thirteen patients (36%) assimilated 13C-labeled uracil. Resting energy expenditure was significantly higher than predicted between 10 and 14 hours after baseline in 33 donors (P = .007). Other measures were not conclusively different between fed and fasting groups. No adverse events occurred that were related to the enteral feeding. Conclusions About 30% of donors metabolized 13C-labeled uracil, although no difference in oxidation rate was found between fasting and fed donors. Corticosteroid administration lowers plasma levels of interleukin 6 and most likely contributes to greater than predicted resting energy expenditure. Thus energy needs may not be met during fasting if hormones are given. Consequences of this possible energy deficit warrant further study.

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Brain Death Effects on Catecholamine Levels and Subsequent Cardiac Damage Assessed in Organ Donors

Cited by 47 publications

References 26 publications

Paradoxical effects of brain death and associated trauma on rat mesenteric microcirculation: an intravital microscopic study

Paradoxical effects of brain death and associated trauma on rat mesenteric microcirculation: an intravital microscopic study

Troponin I levels from donors accepted for pediatric heart transplantation do not predict recipient graft survival

Randomized Trial to Evaluate Nutritional Status and Absorption of Enteral Feeding after Brain Death

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