Hormonal Changes of the Brain-Dead Organ Donors: A 3-Year Experience
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Background: Success of transplantation is critically dependent upon the quality of the donor organ and optimal management. Recently, hormonal replacement therapy has been reported to result in rapid recovery of cardiac function and enable significantly more organs to be transplanted, while some other studies show conflicting results. The aim of this study is to comprehensively evaluate changes in basal circulating hormonal levels of the brain-dead organ donors. Methods: We reviewed the records of all brain-dead patients between January, 2004, and June, 2007. Hemodynamic variables, plasma hormone levels were recorded at following time points: admission to the ICU (T1, baseline), 30 minutes (min) after first apnea test (T2), 30 min after second apnea test (T3), before operation for harvesting (T4). Hormonal measurements included cortisol, adrenocorticotrophic hormone, triiodothyronine (T3), thyroxine, free thyroxine, thyroid-stimulating hormone, growth hormone, and testosterone. Results: Nineteen patients were included in this study. Comparisons of hemodynamic parameters and hormonal levels to baseline values revealed no significant changes throughout the study period. When the patients were divided into 2 groups according to the requirement of norepinephrine (either＞0.05 or ≤0.05μg/kg/min), patients requiring ＞0.05μg/kg/min of norepinephrine had T3 level below the normal range at significantly more time points of measurement (7 vs. 0). Conclusions: In this comprehensive assessment of hormonal levels in brain-dead organ donors, we could not observe any significant changes during the ICU stay. Replacement therapy of T3 may be considered in patients requiring ＞0.05μg/kg/min of norepinephrine.
Abstract
Background: Success of transplantation is critically dependent upon the quality of the donor organ and optimal management. Recently, hormonal replacement therapy has been reported to result in rapid recovery of cardiac function and enable significantly more organs to be transplanted, while some other studies show conflicting results. The aim of this study is to comprehensively evaluate changes in basal circulating hormonal levels of the brain-dead organ donors. Methods: We reviewed the records of all brain-dead patients between January, 2004, and June, 2007. Hemodynamic variables, plasma hormone levels were recorded at following time points: admission to the ICU (T1, baseline), 30 minutes (min) after first apnea test (T2), 30 min after second apnea test (T3), before operation for harvesting (T4). Hormonal measurements included cortisol, adrenocorticotrophic hormone, triiodothyronine (T3), thyroxine, free thyroxine, thyroid-stimulating hormone, growth hormone, and testosterone. Results: Nineteen patients were included in this study. Comparisons of hemodynamic parameters and hormonal levels to baseline values revealed no significant changes throughout the study period. When the patients were divided into 2 groups according to the requirement of norepinephrine (either＞0.05 or ≤0.05μg/kg/min), patients requiring ＞0.05μg/kg/min of norepinephrine had T3 level below the normal range at significantly more time points of measurement (7 vs. 0). Conclusions: In this comprehensive assessment of hormonal levels in brain-dead organ donors, we could not observe any significant changes during the ICU stay. Replacement therapy of T3 may be considered in patients requiring ＞0.05μg/kg/min of norepinephrine.
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