Vasopressin Deficiency and Pressor Hypersensitivity In Hemodynamically Unstable Organ Donors

Abstract

Background-Solid organ donors often develop hypotension due to vasodilation, and recently we observed that a variety of vasodilatory states are characterized by vasopressin deficiency and hypersensitivity. Thus, we investigated the prevalence of vasopressin deficiency in hypotensive solid organ donors without clinical evidence of diabetes insipidus; we also investigated the vasopressor effect of vasopressin replacement in hypotensive donors. Methods and Results-Fifty organ donors were evaluated for hemodynamic instability, (mean arterial pressure [MAP]Յ 70 mm Hg despite the use of catecholamine vasopressors), and in those unstable donors who were not already receiving exogenous vasopressin, low-dose vasopressin was administered as a continuous infusion (0.04 to 0.1 U/min). MAP, catecholamine requirements, serum vasopressin, and serum osmolality were obtained before and after vasopressin administration. Ten patients meeting the enrollment criteria received vasopressin and MAP increased from 72.2Ϯ3.5 to 89.8Ϯ4.2 mm Hg, (PϽ0.05), allowing for complete discontinuation of catecholamine pressors in 4 (40%) patients and a decrement in pressor dose in 4 (40%). Plasma vasopressin levels (2.9Ϯ0.8 pg/mL) were low for the degree of hypotension. Conclusions-Hemodynamically unstable organ donors without clinically apparent diabetes insipidus display a defect in the baroreflex-mediated secretion of vasopressin. In these patients, low-dose vasopressin significantly increases blood pressure with a pressor response sufficient to reduce catecholamine administration. (Circulation. 1999;100[suppl II]:II-244-II-246.

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

“…100 In some cases, fluid resuscitation and dopamine administration is insufficient to restore cardiac afterload, and a vasopressor has to be added. Both norepinephrine 83,89,90 and vasopressin [101][102][103] are recommended, and excellent results have been obtained by both. Vasopressin is effective against diabetes insipidus, and it reduces the hemodynamic need for catecholamines.…”

“…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.…”

Vasopressina plasmática em pacientes submetidos à correção de aneurisma de aorta infrarrenal

“…Chen et al [21] reported plasma AVP levels varying from 2.2 to 8.0 pg/mL in normovolemic patients and normotensive patients, with serum osmolarity ≤ 290 mOsm/L. In a previous study of our group [22], plasma AVP values in 29 healthy adults individuals at rest were also very low (ranging from 0.4 to 5.2 pg/mL).= In the present investigation, preoperative (T0 -basal period) mean plasma AVP levels were of 1.37±0.73 pg/mL (median=1.34 pg/mL; range=0.30 -3.1 pg/mL), thus, inside those previously described by our group [22] in healthy resting adult individuals.…”

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

“…Organ donors who require catecholamine support have been shown to be deficient in vasopressin. 26 Several authors have described the successful support and catecholamine sparing effect of iv vaso-pressin with or without 1-desamino-8-D-arginine vasopressin for up to 14 days after brain death. [27][28][29][30] The catecholamine sparing effects of vasopressin have also been shown in several case series of patients in septic shock.…”

“…26,[89][90][91][92] Unfortunately, in less than 20% of cadaveric donors are lungs retrieved. 93 Pathological studies of lungs deemed unsuitable for donation have indicated that bronchopneumonia, diffuse alveolar damage, and diffuse lung consolidation are the most common reasons for being deemed unsuitable.…”