Norepinephrine infusion in brain dead organ donor: A retrospective study on its effects on graft function after renal transplant

Abstract

Objective: To investigate the effect of vasoactive drugs use in brain-dead organ donors in renal recipient graft function. Material and Methods: Clinical data from 30 brain-dead organ donors, and 30 recipients in our center were analyzed retrospectively between July 2017 and November 2021. Results: Norepinephrine infusion was used in all 30 cadaveric donors, where 11 donors had inotropic combinations. Norepinephrine was infused at a median dose of 0.2mcg/kg/min. There was no relationship between duration and doses of norepinephrine in donors and graft rejection, graft loss, and dialysis requirement in renal recipients. Conclusion: Intravenous norepinephrine infusion below 0.2mcg/kg/min had no effect on graft function in the renal recipient, where fluid restitution was sufficient in the cadaveric donor.

Keywords

• brain dead
• organ donors
• vasoactive drugs
• graft survival

Beyin ölümü organ donörlerinde norepinefrin infüzyonunun greft fonksiyonu üzerine etkileri: Retrospektif bir çalışma

Abstract

Amaç: Beyin ölümü gerçekleşen organ donörlerinde vazoaktif ilaç kullanımının renal alıcı greft fonksiyonu üzerindeki etkisini araştırmak. Yöntemler: Merkezimizde Temmuz 2017 ile Kasım 2021 arasında, beyin ölümü gerçekleşen 30 organ bağışçısından ve 30 alıcıdan alınan klinik veriler geriye dönük olarak analiz edilmiştir. Bulgular: 30 kadavra donörünün hepsinde norepinefrin infüzyonu kullanılmıştı. 11 donörün inotrop ilaç kombinasyonuna sahip olduğu görüldü. Norepinefrin infüzyonlarının ortalama dozu 0.2 mcg/kg/dk idi. Donörlerde norepinefrin süresi ve dozları ile böbrek alıcılarında greft reddi, greft kaybı ve diyaliz gereksinimi arasında ilişki yoktu. Sonuç: Beyin ölümü organ bağışçısında sıvı resüstasyonunun yeterli olduğu durumlarda .0.2 mcg/kg/dk'nın altındaki intravenöz norepinefrin infüzyonunun, renal greft fonksiyonu üzerine etkisi olmadığı görüldü.

Keywords

• Beyin ölümü
• donör
• vazoaktif ilaçlar
• greft sağkalımı

References

1. Citerio G, Cypel M, Dobb GJ, et al. Organ donation in adults: a critical care perspective. Intensive Care Med.2016;42 (3): 305–315. https://doi.org/10.1007/s00134-015-4191-5
2. Organ Donation Statistics. https://www.organdonor.gov/learn/organ-donation-statistics
3. TDIS KDS Public Information Pages https://organkds.saglik.gov.tr/dss/PUBLIC/PublicDefault2.aspx
4. Person-organ-transplant-waiting-lives. https://www.tonv.org.tr/en/
5. Lazzeri C, Bonizzoli M, Guetti C, Fulceri GE, and Peris A. Hemodynamic management in brain dead donors. World J Transplant. 2021;11(10): 410–420. https://doi.org/10.5500/wjt.v11.i10.410
6. Smith M. Physiologic changes during brainstem death-lessons for management of the organ donor. J Heart Lung Transplant. 2004;23(9):217–222. doi:10.1016/j.healun.2004.06.017
7. Ignacio Martin-Loeches ,Sandiumenge A , Charpentier J, et al. Management of donation after brain death (DBD) in the ICU: the potential donor is identified, what’s next? Intensive Care Med. 2019;45(3):322-330. https://doi.org/10.1007/s00134-019-05574-5
8. Kotloff RM, Blosser S, Fulda GJ, et al. Management of the potential organ donor in the ICU: society of critical care medicine/American college of chest physicians/association of organ procurement organizations consensus statement. Crit Care Med. 2015;43(6):1291–1325. https://doi.org/10.1097/CCM.0000000000000958

9. Stoica SC, Satchithananda DK, White PA, et al. Noradrenaline use in the human donor and relationship with load-independent right ventricular contractility. Transplantation. 2004;78(8):1193–1197. https://doi.org/10.1097/01.tp.0000137792.74940.4f
10. Schnuelle P, Gottmann U, Hoeger S, et al. Effects of donor pretreatment with dopamine on graft function after kidney transplantation : a randomized controlled trial. JAMA. 2009;302(10):1067– 1075. https://doi.org/10.1001/jama.2009.1310
11. Birtan D, Arslantas MK, Altun GT, et al. Effect of vasoactive therapy used for braindead donors on graft survival after kidney transplantation. Transplant Proc.2018;50(5):1289–1291. https://doi.org/10.1016/j.transproceed.2018.02.058
12. Maciel CB, Greer DM. ICU Management of the Potential Organ Donor: State of the Art. Curr Neurol and Neurosci Rep. 2016;16(9):86. https://doi.org/10.1007/s11910-016-0682-1
13. Moreno-Camacho C A, Montoya-Torres JR, Jaegler A and Gondran N. Sustainability metrics for real case applications of the supply chain network design problem: A systematic literature review. Journal of Cleaner Production. 2019; 231:600-618. https://doi.org/10.1016/j.jclepro.2019.05.278
14. Lesieur O, Genteuil L and Leloup M. A few realistic questions raised by organ retrieval in the intensive care unit. Ann Transl Med. 2017; 5(4):44. https://doi.org/10.21037/atm.2017.05.08
15. Sawinski D, Forde K A, Re VL, et al. Mortality and Kidney Transplantation Outcomes Among Hepatitis C Virus–Seropositive Maintenance Dialysis Patients: A Retrospective Cohort Study. Am J KidneyDis. 2019;73(6):815–826. https://doi.org/10.1053/j.ajkd.2018.11.009
16. Schnuelle P, Schmitt W H, Weiss C, et al. Effects of dopamine donor pretreatment on graft survival after kidney transplantation: a randomized trial. Clin J Am Soc Nephrol. 2017; 12(3): 493-501. https://doi.org/10.2215/CJN.07600716
17. Benck U, Jung M, Krüger B, et al. Donor Dopamine Does Not Affect Liver Graft Survival: Evidence of Safety From a Randomized Controlled Trial. Liver Transplantation, 24(10), 1336-1345. https://doi.org/10.1002/lt.25301
18. Sun Q, Huang Z, Zhou H, et al. New Factors Predicting Delayed Graft Function: aMulti-Center Cohort Study of Kidney Donation After Brain Death Followed by Circulatory Death. Kidney Blood Press Res 2018;43(3):893–903. https://doi.org/10.1159/000490337
19. Peris A, Lazzeri C, D’Antonio L, et al. Epidemiological changes in potential heart donors after brain death: a retrospective 15 year cohort study. Internal and Emergency Medicine. 2019;14(3): 371-375. https://doi.org/10.1007/s11739-018-1897-8
20. O’Brien EA, Bour SA, Marshall RL, Ahsan N, Yang HC .Effect of use of vasopressors in organ donors on immediate function of renal allografts. Journal of Transplant Coordination. 1996; 6(4):215-216. https://doi.org/10.7182/prtr.1.6.4.e1g711321k55563r
21. Shao M, Ye O, Ming Y, et al. Delayed graft function after DCD kidney transplantation: risk factors for and impact on transplantation. Zhong nan da xue xue bao. Yi xue ban= Journal of Central South University. Medical Sciences, 37(10), 1045-1049. https://doi.org/10.3969/j.issn.1672-7347.2012.10.013
22. Maciel CB, Greer DM. ICU management of the potential organ donor: state of the art. Current neurology and neuroscience reports. 2016;16(9):1-12. https://doi.org/10.1007/s11910-016-0682-1
23. Yarlagadda SG, Coca SG, Formica Jr RN, Poggio ED, Parikh CR. Association between delayed graft function and allograft and patient survival: a systematic review and meta-analysis. Nephrology dialysis transplantation. 2009; 24(3), 1039-1047. doi:10.1093/ndt/gfn667
24. Helfer MS, Vicari AR, Spuldaro F, Gonçalves LFS, Manfro RC. Incidence, risk factors, and outcomes of delayed graft function in deceased donor kidney transplantation in a Brazilian center. In Transplantation proceedings. 2014;46(6):1727-1729. https://doi.org/10.1016/j.transproceed.2014.05.026
25. Kotloff RM, Blosser S, Fulda G J, et al. Management of the potential organ donor in the ICU: society of critical care medicine/American college of chest physicians/association of organ procurement organizations consensus statement. Critical care medicine. 2015;43(6):1291-1325. https://doi.org/10.1097/CCM.0000000000000958
26. Bassi E, Park M and Azevedo LCP. Therapeutic Strategies for High-Dose Vasopressor-Dependent Shock. Crit Care Res Pract. 2013;2013:654708. https://doi.org/10.1155/2013/654708