Change From Aerobic to Anaerobic Metabolism After Brain Death, and Reversal Following Triiodothyronine Therapy

Novitzky, D.; Cooper, D. K. C.; Morrell, D.F.; Isaacs, Sedick

doi:10.1097/00007890-198801000-00008

Cited by 252 publications

(116 citation statements)

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“…Diabetes insipidus with polyuria and dehydration derives from the lowering of the ADH level, leading to hypovolemia and, possibly, hypoperfuison of the organs. Low T3 syndrome (sick euthyroid syndrome) characterizes the changes in levels of thyroid hormones with a shift from aerobic to anaerobic metabolism [17], which has been also observed under various types of hypotension [lo, 19, 321. These factors mentioned above are considered to be responsible for the deterioration of graft viability [6,15,16].…”

Section: Discussionmentioning

confidence: 99%

Role of hypotension in brain-death associated impairment of liver microcirculation and viability

Okamoto

Corso²,

Leiderer³

et al. 2000

Transplant International

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Hypotension in braindead organ donors is considered a determinant factor of graft viability. The aim of this study was to elucidate the role of hypotension in brain-death associated impairment of hepatic microcirculation and function. Male Sprague-Dawley rats with an intracranial balloon were used. Group I (n = 7) served as sham controls. In group I1 (n = 7) brain death was induced through inflation of an intracranial balloon. In group I11 (n = 7) hypotension without brain death was induced by means of pentobarbital. In group 11, a steep rise of arterial pressure was followed by a fall to a lower level ( P < 0.01, vs. group I). Also in group 111 arterial pressure was lower ( P < 0.01, vs. group I). In group 11, bile production was diminished ( P < 0.05). Impaired sinusoidal perfusion ( P < 0.01) and enhanced leukocyte endothelium interaction ( P < 0.05) were documented in hepatic microvasculature. Electron microscopic analysis revealed vacuolization of hepatocytes; these changes were not observed in group 111. Brain death induces specific changes of liver microcirculation, function and histomorphology. Independent of associated hypotension, brain death per se impairs donor liver graft quality.

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Section: Discussionmentioning

confidence: 99%

Role of hypotension in brain-death associated impairment of liver microcirculation and viability

Okamoto

Corso²,

Leiderer³

et al. 2000

Transplant International

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“…32,[36][37][38] The deterioration of cardiac function, the need for inotropic support, and the metabolic changes could be reversed by T3 supplementation. 37,38 Other studies, however, could not confirm these results, 39 and in most human studies there is no correlation between plasma T3 levels, cardiac function, and the need for inotropic support. [40][41][42] In a review by Powner and Hernandez, 43 it was concluded that routine replacement of thyroid hormones for all donors could not be advocated.…”

Section: Pulmonary Changesmentioning

confidence: 99%

Brain death and its implications for management of the potential organ donor

Bugge

2009

Acta Anaesthesiol Scand

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The systemic physiologic changes that occur during and after brain death affect all organs suitable for transplantation. Major changes occur in the cardiovascular, pulmonary, endocrine, and immunological systems, and, if untreated may soon result in cardiovascular collapse and somatic death. Understanding these complex physiologic changes is mandatory for developing effective strategies for donor resuscitation and management in such a way that the functional integrity of potentially transplantable organs is maintained. This review elucidates these physiological changes and their consequences, and based on these consequences the rationale behind current medical management of brain-dead organ donors is discussed.

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“…5 In a further study, 6 beneficial effects of hormonal therapy in donor management were shown. However, other studies in the literature, although they do document hormonal changes in the brain-dead animals or the donors, could not find any benefit in hormonal therapy.…”

Section: Haemodynamic and Metabolic Effects Of Brain Death On The Donmentioning

confidence: 92%

Transplantation of the heart: An overview of 40 years' clinical and research experience at Groote Schuur Hospital and the University of Cape Town: Part II. Laboratory research experience.

Hassoulas

2012

S Afr Med J

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Change From Aerobic to Anaerobic Metabolism After Brain Death, and Reversal Following Triiodothyronine Therapy

Cited by 252 publications

References 0 publications

Role of hypotension in brain-death associated impairment of liver microcirculation and viability

Role of hypotension in brain-death associated impairment of liver microcirculation and viability

Brain death and its implications for management of the potential organ donor

Transplantation of the heart: An overview of 40 years' clinical and research experience at Groote Schuur Hospital and the University of Cape Town: Part II. Laboratory research experience.

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