Effects of catecholamine application to brain-dead donors on graft survival in solid organ transplantation1

Schnuelle, Peter; Berger, Stefan P.; Boer, Jacob de; Persijn, G. G.; Woude, Fokko J. van der

doi:10.1097/00007890-200108150-00017

Cited by 155 publications

(103 citation statements)

References 70 publications

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“…Norepinephrine was used because it is the (4). Similarly high rates of catecholamine administration have been reported in other registries such as the Eurotransplant registry, where 91% of brain-dead donors were maintained with catecholamines and one-third donors receiving more than one catecholamine infusion (33).…”

Section: Discussionsupporting

confidence: 69%

The Effects of Hormone Resuscitation on Cardiac Function and Hemodynamics in a Porcine Brain-Dead Organ Donor Model

Hing

Hicks

Garlick

et al. 2007

American Journal of Transplantation

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We compared the effects of hormone resuscitation (HR) with a norepinephrine-based protocol on cardiac function, hemodynamics and need for vasopressor support after brain death in a porcine model. Following brain death induction, animals were treated with norepinephrine and fluids for 3 h. In the following 3 h, they continued on norepinephrine and fluids (control) or received additional HR (triiodothyronine, methylprednisolone, vasopressin, insulin). Data were collected pre-brain death, 3 and 6 h post-brain death. At 6 h, median norepinephrine use was higher in controls (0.563 vs. 0 lg/kg/min; p < 0.005), with 6/8 HR animals weaned off norepinephrine compared with 0/9 controls. Mean arterial pressure was higher in HR animals at 6 h (74 ± 17 vs. 54 ± 14 mmHg; p < 0.05). Cardiac contractility was also significantly higher in HR animals at 6 h (stroke work index 1.777 vs. 1.494). After collection of 6 h data, all animals were placed on the same low dose of norepinephrine. At 6.25 h, HR animals had higher stroke work (3540 ± 1083 vs. 1536 ± 702 mL.mmHg; p < 0.005), stroke volume (37.2 ± 8.2 vs. 21.5 ± 9.8 mL; p < 0.01) and cardiac output (5.8 ± 1.4 vs. 3.2 ± 1.2 L/min; p < 0.005). HR in a porcine model of brain death reduces norepinephrine requirements, and improves hemodynamics and cardiac function. These results support the use of HR in the management of the brain-dead donor.

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Section: Discussionsupporting

confidence: 69%

The Effects of Hormone Resuscitation on Cardiac Function and Hemodynamics in a Porcine Brain-Dead Organ Donor Model

Hing

Hicks

Garlick

et al. 2007

American Journal of Transplantation

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“…Very high doses of catecholamines administered to experimental animals have induced damage to the myocardium similar to the changes induced by the sympathetic storm during brain death, [9][10][11] and the use of norepinephrine to donors has been related to primary nonfunction in heart transplantation. 87 This has led to high numbers of donors refused by cardiac surgeons exclusively due to the doses of catecholamines used. 88 However, excellent outcomes have been reported in heart transplant recipients from donors managed with high doses of dopamine and norepinehrine 89 and, as discussed previously, restoring the loading conditions of the heart after loss of sympathetic tone is essential for maintaining and improving cardiac performance after brain death.…”

Section: Hemodynamic Managementmentioning

confidence: 99%

“…Vasopressin is effective against diabetes insipidus, and it reduces the hemodynamic need for catecholamines. 101,102 In addition to the association with primary nonfunction, 87 norepinephrine has been related to reduced right ventricular contractility and reduced 1-year survival in heart transplantation. 104 However, these data are retrospective, and no causal connection between norepinephrine and outcome has been demonstrated.…”

Section: Hemodynamic Managementmentioning

confidence: 99%

Brain death and its implications for management of the potential organ donor

Bugge

2009

Acta Anaesthesiol Scand

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The systemic physiologic changes that occur during and after brain death affect all organs suitable for transplantation. Major changes occur in the cardiovascular, pulmonary, endocrine, and immunological systems, and, if untreated may soon result in cardiovascular collapse and somatic death. Understanding these complex physiologic changes is mandatory for developing effective strategies for donor resuscitation and management in such a way that the functional integrity of potentially transplantable organs is maintained. This review elucidates these physiological changes and their consequences, and based on these consequences the rationale behind current medical management of brain-dead organ donors is discussed.

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“…There is some evidence supporting dopamine as a first choice inotrope, in doses of less than 10 mcg/kg/min. The same analysis found that norepinephrine administration was associated with an increased incidence of cardiac graft failure, but similar negative effect was not observed with dopamine, dobutamine, and epinephrine [14]. In addition to the improved oxygen delivery, there are further possible explanations for the salutary effects of adrenergic drugs.…”

Section: Donor Managementmentioning

confidence: 88%

Organ Donation : Intensive Care Issues in Managing Brain Dead

Murthy

2009

Medical Journal Armed Forces India

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Organ donation and transplantation is one of the most powerful and dramatic practices in modern medicine. It is the pinnacle of centuries of dreams, massive amounts of accrued knowledge and impressive technical developments. One organ donor has the potential of saving more than five lives and impacting the quality of life of many others via tissue donation. The clinical team has a responsibility to the donor families and the recipient patient to do everything possible to provide best practices supported by the best evidence. These standardized best practices should come from the published evidence which is adapted for use in the specific environment, culture, and infrastructure of the institution.

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Effects of catecholamine application to brain-dead donors on graft survival in solid organ transplantation1

Cited by 155 publications

References 70 publications

The Effects of Hormone Resuscitation on Cardiac Function and Hemodynamics in a Porcine Brain-Dead Organ Donor Model

The Effects of Hormone Resuscitation on Cardiac Function and Hemodynamics in a Porcine Brain-Dead Organ Donor Model

Brain death and its implications for management of the potential organ donor

Organ Donation : Intensive Care Issues in Managing Brain Dead

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