Impairment of early graft function by desmopressin in pancreatic transplantation - Optimization of application proceeding organ harvesting

Citation
T. Keck et al., Impairment of early graft function by desmopressin in pancreatic transplantation - Optimization of application proceeding organ harvesting, LANG ARCH S, 1999, pp. 615-620
Citations number
9
Language
TEDESCO
art.tipo
Article
Categorie Soggetti
Surgery
Journal title
LANGENBECKS ARCHIVES OF SURGERY
ISSN journal
1435-2443 → ACNP
Year of publication
1999
Supplement
1
Pages
615 - 620
Database
ISI
SICI code
1435-2443(1999):<615:IOEGFB>2.0.ZU;2-E
Abstract
Background: 40-80% of brain-dead potential organ donors develop a central d iabetes insipidus (CDI). Desmopressin (dDAVP) is conventionally used in int ensive care units to prevent hypovolemia, hyponatriemia and hypotension. Aim of this study was to evaluate the effects of desmopressin on microcircu lation in donor organs and early allograft function after pancreas transpla ntation. Methods: 30 male Brattleboo rats with hereditary CDI served as model of the organ donor. An evaluation of microcirculatory parameters was performed in organ donor model and 1 h and 6 h after reperfusion after autologous pancr eas transplantation. Results: In organ donor groups those pretreated with i.v. desmopressin show ed increased rolling (1694 +/- 351/mm(2)) and a reduced capillary erythrocy te velocity (0.34 +/- 0.11 mm/s) compared to controls (491 +/- 227/mm(2) or 0.91 +/- 0.11 mm/s) 60 min after application. After transplantation pretre ated donors showed reduced erythrocyte blood flow velocities as well as inc reased rolling and sticking (p < 0.05). Conclusion: Desmopressin in repeated application and application in the mod el of organ donor with CDI one hour before explantation leads to impairment of microcirculation and increased leucocyte endothelial interaction in don or and 6 h after reperfusion. The effects of desmopressin can be expained b y increased vasoconstriction, p-selectin liberation out of weibel palade bo dies and activation of thrombocytes. 60 min before organ explantation indic ation for application of desmopressin has to be questioned.