Abstract
Background: Administration of terlipressin can reverse hypotension in potential organ donors with norepinephrine-resistance. The aim of this study was to determine the effects of terlipressin on the hemodynamics, liver function, and renal function of hypotensive brain-dead patients who were potential organ donors. Methods: A retrospective study was conducted by using the ICU database of one hospital. 18 patients in a total of 294 brain-dead cases were enrolled and administered terlipressin intravenously. All physiological parameters of recruited patients were obtained at baseline, 24 and 72 h after administration, and immediately before organ procurement. Results: Terlipressin induced significant increases in mean arterial pressure (MAP) from 69.56 ± 10.68 mm Hg (baseline) to 101.82 ± 19.27 mm Hg (immediately before organ procurement) and systolic blood pressure (SBP) from 89.78 ± 8.53 mm Hg (baseline) to 133.42 ± 26.11 mm Hg (immediately before organ procurement) in all patients. The increases in MAP were accompanied by significant decreases in heart rate (HR) from 113.56 ± 28.43 bpm (baseline) to 83.89 ± 11.70 bpm (immediately before organ procurement), which resulted in the decrease of norepinephrine dose over time from 0.8 ± 0.2 μg/kg/min (baseline) to 0.09 ± 0.02 μg/kg/min (immediately before organ procurement). There were no changes in central venous pressure, liver function including aspartate aminotransferase (AST), alanine aminotransferase (ALT), and bilirubin. Renal function, assessed by serum creatinine (SCr), urine output (UOP), creatinine clearance rate (CCr), and estimated glomerular filtration rate (eGFR), improved significantly. Conclusion: Our analysis of brain-dead patients with hypotension indicates that administration of terlipressin can significantly increases MAP, SBP, UOP, CCr, and eGFR, while decreases HR and Scr. Terlipressin appears to help maintain hemodynamic stability, reduce vasoactive support, and improve renal function.
Highlights
Organ transplantation is considered as the optimal treatment for many patients with end-stage organ disease (Schnitzler et al, 2005; Weinrauch and D’Elia 2018)
The increases in mean arterial pressure (MAP) were accompanied by significant decreases in heart rate (HR) from 113.56 ± 28.43 bpm to 83.89 ± 11.70 bpm, which resulted in the decrease of norepinephrine dose over time from 0.8 ± 0.2 μg/kg/min to 0.09 ± 0.02 μg/kg/min
There were no changes in central venous pressure, liver function including aspartate aminotransferase (AST), alanine aminotransferase (ALT), and bilirubin
Summary
Organ transplantation is considered as the optimal treatment for many patients with end-stage organ disease (Schnitzler et al, 2005; Weinrauch and D’Elia 2018). There is a widening disparity between the number of patients and the availability of suitable organs from brain-dead donors (Merchant et al, 2010; Matesanz et al, 2012). Maintenance of the donor status after brain death may help to increase the number and quality of available organs (Linos et al, 2007). The challenge for physicians in the intensive care unit (ICU) is maintaining adequate organ perfusion and metabolism in braindead patients who are to become organ donors (Kotloff et al, 2015). Due to the great potential benefit from organ donation, optimal ICU management strategies should be applied to maintain viable organs after confirmation of clinical brain death. The aim of this study was to determine the effects of terlipressin on the hemodynamics, liver function, and renal function of hypotensive braindead patients who were potential organ donors
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