Understanding the effect of corticosteroid pretreatment in brain-dead organ donors: new mechanistic insights for improvement of organ quality in liver transplantation

2017 ◽  
Vol 131 (18) ◽  
pp. 2377-2379
Author(s):  
Carola Dahrenmöller ◽  
Raymond Reding
Keyword(s):  
Liver Transplantation ◽  
Liver Function ◽  
Molecular Mechanisms ◽  
Organ Donors ◽  
Liver Transplants ◽  
Long Time ◽  
Organ Quality ◽  
Brain Dead ◽  
Brain Dead Donor

Transplant surgeons are currently faced with the challenge to accept marginal liver transplants due to steatosis or old age. Improving organ quality by implementing a selective organ protective donor management could be the first step towards a graft of enhanced quality. However, the molecular mechanisms of such treatments are still poorly understood. Glucocorticoid medication in donor medicine has been carried out and discussed for a long time. In a recent study published in Clinical Science, Jiménez-Castro et al. [Clin. Sci. (2017) 131, 733-746] demonstrate how liver histology and transplant liver function can be improved by administration of glucocorticoids to brain-dead donor rats with steatotic livers. This work illustrates the need for further trials in order to selectively improve the quality of steatotic livers with a potential for liver transplantation.

scholarly journals Liver Transplantation and Quality of Life

2000 ◽  
Vol 14 (8) ◽  
pp. 693-699 ◽  
Author(s):  
J Rodés ◽  
M Navasa
Keyword(s):  
Quality Of Life ◽  
Liver Transplantation ◽  
Survival Rate ◽  
Late Complications ◽  
Liver Transplants ◽  
Physical Conditions ◽  
The World ◽  
Liver Transplantations ◽  
Validated Instrument

To date, more than 50,000 liver transplantations have been performed around the world; the survival rate five years after transplantation ranges from 60% to 65%. One of the fundamental objectives for liver transplantation teams is to achieve the best possible quality of life (QOL) for the patients. A concise analysis of the methodology used (15 questionnaires) to measure QOL of patients with liver transplants is described. The authors suggest that now is the time to establish a database so that a validated instrument will be available to compare QOL results from all the liver transplantation programs. Liver transplantation is believed to improve QOL, although there are several problems with some of the papers published on this subject. Some studies are retrospective, whereas in others, patients in bad physical conditions are excluded from the study; in quite a few prospective studies, deaths are not included in the data analysis. Finally, the authors provide a brief, concise analysis of late complications and of recurrence of the disease after liver transplantation, which influence QOL.

The effect of cortisol in rat steatotic and non-steatotic liver transplantation from brain-dead donors

2017 ◽  
Vol 131 (8) ◽  
pp. 733-746 ◽  
Author(s):  
Mónica B. Jiménez-Castro ◽  
Elsa Negrete-Sánchez ◽  
Araní Casillas-Ramírez ◽  
Jose Gulfo ◽  
Ana I. Álvarez-Mercado ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Graft ◽  
Steatotic Liver ◽  
Kinase C ◽  
Protective Strategy ◽  
Brain Dead ◽  
Underlying Mechanisms ◽  
Phosphoinositide 3 Kinase ◽  
Brain Dead Donor

In the present study, we examined the effects of cortisol on steatotic and non-steatotic liver grafts from brain-dead donors and characterized the underlying mechanisms involved. Non-steatotic liver grafts showed reduced cortisol and increased cortisone levels in association with up-regulation of enzymes that inactivate cortisol. Conversely, steatotic liver grafts exhibited increased cortisol and reduced cortisone levels. The enzymes involved in cortisol generation were overexpressed, and those involved in cortisol inactivation or clearance were down-regulated in steatotic liver grafts. Exogenous administration of cortisol negatively affected hepatic damage and survival rate in non-steatotic liver transplantation (LT); however, cortisol treatment up-regulated the phosphoinositide 3-kinase (PI3K)–protein kinase C (PKC) pathway, resulting in protection against the deleterious effects of brain-dead donors on damage and inflammatory response in steatotic LT as well as in increased survival of recipients. The present study highlights the differences in the role of cortisol and hepatic mechanisms that regulate cortisol levels based on the type of liver. Our findings suggest that cortisol treatment is a feasible and highly protective strategy to reduce the adverse effects of brain-dead donor livers in order to ultimately improve liver graft quality in the presence of steatosis, whereas cortisol treatment would not be recommended for non-steatotic liver grafts.

scholarly journals Effects of Terlipressin on Management of Hypotensive Brain-Dead Patients Who are Potential Organ Donors: A Retrospective Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Donghua Zheng ◽  
Genglong Liu ◽  
Li Chen ◽  
Wenfeng Xie ◽  
Jiaqi Sun ◽  
...  
Keyword(s):  
Renal Function ◽  
Retrospective Study ◽  
Liver Function ◽  
Estimated Glomerular Filtration Rate ◽  
Organ Procurement ◽  
Venous Pressure ◽  
Organ Donors ◽  
Hemodynamic Stability ◽  
Norepinephrine Dose ◽  
Brain Dead

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.

scholarly journals Influence of Donor Brain Death on Chronic Rejection of Renal Transplants in Rats

2001 ◽  
Vol 12 (11) ◽  
pp. 2474-2481 ◽  
Author(s):  
JOHANN PRATSCHKE ◽  
MARKUS J. WILHELM ◽  
IGOR LASKOWSKI ◽  
MAMORU KUSAKA ◽  
FRANCISCA BEATO ◽  
...  
Keyword(s):  
Brain Death ◽  
Chronic Rejection ◽  
Host Responses ◽  
Renal Transplants ◽  
Term Survival ◽  
Organ Quality ◽  
Brain Dead ◽  
And Function ◽  
Brain Dead Donor

Abstract. The clinical observation that the results of kidney grafts from living donors (LD), regardless of relationship with the host, are consistently superior to those of cadavers suggests an effect of brain death (BD) on organ quality and function. This condition triggers a series of nonspecific inflammatory events that increase the intensity of the acute immunologic host responses after transplantation (Tx). Herein are examined the influences of this central injury on late changes in renal transplants in rats. A standardized model of BD was used. Groups included both allografts and isografts from normotensive braindead donors and anesthetized LD. Renal function was determined every 4 wk after Tx, at which time representative grafts were examined by morphology and by reverse transcriptase—PCR. Long-term survival of brain-dead donor transplants was significantly less than LD grafts. Proteinuria was significantly elevated in recipients of grafts from BD donors versus LD controls as early as 6 wk postoperatively and increased progressively through the 52-wk follow up. These kidneys also showed consistently more intense and progressive deterioration in renal morphology. Changes in isografts from brain-dead donors were less marked and developed at a slower tempo than in allografts but were always greater than those in controls. The transcription of cytokines was significantly increased in all brain-dead donor grafts. Donor BD accelerates the progression of long-term changes associated with kidney Tx and is an important risk factor for chronic rejection. These results explain in part the clinically noted difference in long-term function between organs from cadaver and living sources.

scholarly journals Management of the brain-dead donor in the ICU: general and specific therapy to improve transplantable organ quality

2019 ◽  
Vol 45 (3) ◽  
pp. 343-353 ◽  
Author(s):  
Geert Meyfroidt ◽  
Jan Gunst ◽  
Ignacio Martin-Loeches ◽  
Martin Smith ◽  
Chiara Robba ◽  
...  
Keyword(s):  
Specific Therapy ◽  
Organ Quality ◽  
Brain Dead ◽  
The Brain ◽  
Brain Dead Donor

scholarly journals Deceased Brain Dead Donor Liver Transplantation and Utilization in the United States

2019 ◽  
Vol 103 (7) ◽  
pp. 1392-1404
Author(s):  
Dustin J. Carpenter ◽  
Mariana C. Chiles ◽  
Elizabeth C. Verna ◽  
Karim J. Halazun ◽  
Jean C. Emond ◽  
...  
Keyword(s):  
United States ◽  
Liver Transplantation ◽  
The United States ◽  
Donor Liver ◽  
Donor Liver Transplantation ◽  
Brain Dead ◽  
Brain Dead Donor

FGF15 improves outcomes after brain dead donor liver transplantation with steatotic and non-steatotic grafts in rats

2020 ◽  
Vol 73 (5) ◽  
pp. 1131-1143 ◽  
Author(s):  
José Gulfo ◽  
Floriana Rotondo ◽  
Cindy G. Ávalos de León ◽  
María Eugenia Cornide-Petronio ◽  
Carla Fuster ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Donor Liver ◽  
Donor Liver Transplantation ◽  
Brain Dead ◽  
Brain Dead Donor

scholarly journals Two and a Half Hours of Cardiopulmonary Resuscitation in a Deceased Brain Dead Donor before Liver Transplantation - A Good Idea to Accept?

Chirurgia ◽  
2017 ◽  
Vol 112 (1) ◽  
pp. 46
Author(s):  
Dieter P. Hoyer ◽  
Gernot M. Kaiser ◽  
Andreas Paul ◽  
Nikolaos Machairas ◽  
Ernesto P. Molmenti ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Cardiopulmonary Resuscitation ◽  
Brain Dead ◽  
Brain Dead Donor
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