Thyroid Hormone Therapy in the Management of 63,593 Brain-Dead Organ Donors

Novitzky, D.; Mi, Zhibao; Sun, Qing; Collins, Joseph F.; Cooper, David K. C.

doi:10.1097/tp.0000000000000187

Cited by 107 publications

(80 citation statements)

References 15 publications

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“…Using the recommended protocol in cardiac donors as well as treating the recipients with T3 has shown improved outcome in one study (31), and use of T3 or T4 in potential donors showed increase in the number of organs successfully transplanted, with no detrimental effect on graft survival in a large retrospective cohort study of 63,593 donors over 10 years (82). However, several randomized clinical trials failed to substantiate these findings (31).…”

Section: Brain-dead Potential Organ Donorsmentioning

confidence: 94%

“…Increased mortality associated with low T3 levels is also correlated with increased cardiac risk factors, such as coronary calcification scores and arterial stiffness (72), lower left ventricular ejection fracture and higher mass index (63). Low free T3 and high rT3 levels have also been associated with increased risk for mortality in patients in the intensive care unit (ICU) (89,105), hospitalized cardiac patients (82), patients with congestive heart failure (CHF) (40,92) and patients with liver cirrhosis (34). Others have reported that the presence of nonthyroidal illness portends worsened overall prognosis in patients with enterocutaneous fistulas (49) and in burn patients (42).…”

Section: Treatment Of the Euthyroid Sick Syndromementioning

confidence: 98%

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Euthyroid Sick Syndrome

Lee

Farwell

2016

Comprehensive Physiology

130

116

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In this review, we discuss the characteristics, pathophysiology, and therapeutic implications of the euthyroid sick syndrome. Multiple mechanisms have been identified to contribute to the development of euthyroid sick syndrome, including alterations in the iodothyronine deiodinases, thyroid-stimulating hormone secretion, thyroid hormone binding to plasma protein, transport of thyroid hormone in peripheral tissues, and thyroid hormone receptor activity. The euthyroid sick syndrome appears to be a complex mix of physiologic adaptation and pathologic response to acute illness. The underlying cause for these alterations has not yet been elucidated. Treatment of the euthyroid sick syndrome with thyroid hormone to restore normal serum thyroid hormone levels in an effort to improve disease prognosis and outcomes continues to be a focus of many clinical studies, although currently available data do not provide evidence of a clear benefit of treatment.

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Section: Brain-dead Potential Organ Donorsmentioning

confidence: 94%

Section: Treatment Of the Euthyroid Sick Syndromementioning

confidence: 98%

Euthyroid Sick Syndrome

Lee

Farwell

2016

Comprehensive Physiology

130

116

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“…T 3 /T 4 therapy was originally introduced to improve the hemodynamic status of potential heart donors, and, although there is increasing evidence of its association with increased procurement of several other organs, 15 arguably it has its greatest impact on procurement of the heart.…”

Section: Perspectivementioning

confidence: 99%

Increased Procurement of Thoracic Donor Organs After Thyroid Hormone Therapy

Novitzky

Collins

et al. 2015

Seminars in Thoracic and Cardiovascular Surgery

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“…À ce jour, à l'inverse des recommandations nord-américaines [14,15], une supplémentation hormonale thyroïdienne n'est pas retenue dans les recommandations françaises. Récemment, Novitzky et al ont analysé l'effet de l'administration d'hormones thyroïdiennes chez 65 000 DDME [56]. Les auteurs observaient avec une analyse multivariée que l'administration de ce traitement permettait de prélever davantage d'organes.…”

Section: Supplémentation Hormonaleunclassified

Conséquences cardiovasculaires de la mort cérébrale et prise en charge pour prélèvement d’organe(s)

Champigneulle

Charpentier

2015

Réanimation

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La mort encéphalique (ME) est susceptible d'entraîner une dysfonction cardiocirculatoire, par l'intermé-diaire de différents mécanismes résultant de l'ischémie céré-brale : orage catécholaminergique, dysfonction neurohormonale et inflammation systémique. Cette dysfonction cardiovasculaire est potentiellement exacerbée par les anté-cédents du potentiel donneur décédé en mort encéphalique (DDME) et le contexte clinique dans lequel survient la ME. La détection et la prise en charge d'une défaillance hémo-dynamique survenant dans ce contexte sont cruciales dans le but de préserver la viabilité des greffons potentiels, mais aussi de tenter d'en améliorer la qualité et d'en augmenter le nombre. Cette prise en charge hémodynamique nécessite de connaître la physiopathologie de la ME et d'utiliser un monitorage. Elle repose sur l'administration d'agents inotropes en cas de dysfonction myocardique, la correction d'une hypovolémie et l'administration d'amines vasopressives. En l'état actuel, une opothérapie substitutive (hormones thyroï-diennes, glucocorticoïdes) ne peut être recommandée. Les principales mesures associées indispensables sont : la correction des désordres électrolytiques et métaboliques, la lutte contre l'hypothermie et le traitement d'un diabète insipide. Une réanimation « agressive » du potentiel DDME doit être poursuivie jusqu'au clampage aortique au bloc opératoire. Le sujet en ME, potentiel donneur d'organe(s), doit être considéré comme un « patient » de réanimation à part entière. Mots clés Mort encéphalique · Prélèvement d'organe · Réanimation · Gestion hémodynamiqueAbstract During brain death (BD) process, several mechanisms may induce cardio-circulatory failure. These mechanisms are secondary to brain ischemia and involve a catecholamine storm, a systemic inflammatory state and a hormonal dysfunction. Donor past history and associated medical context may worsen the hemodynamic failure. Objectives of early recognition and treatment of cardiocirculatory failure in potentials BD donors are: to preserve the viability of the potential grafts, to improve organ's function and to increase the number of recovered organs. Hemodynamic resuscitation is principally based on the use of inotropic agents in case of myocardial dysfunction, the correction of hypovolemia and the use of vasopressors (norepinephrine) adapted using a cardiovascular monitorage. Systematic hormone therapy is still debated. Associated supportive treatment includes correction of metabolic and electrolytic disorders, avoidance of hypothermia and management of diabetes insipidus. Aggressive management must be conducted until aortic clamping during organ recovery in operating room. Potential BD donor must be managed like any other intensive care unit patient.

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Thyroid Hormone Therapy in the Management of 63,593 Brain-Dead Organ Donors

Abstract: T3/T4 therapy results in more transplantable organs, with no detriment to posttransplantation graft survival.

Cited by 107 publications

References 15 publications

Euthyroid Sick Syndrome

Euthyroid Sick Syndrome

Increased Procurement of Thoracic Donor Organs After Thyroid Hormone Therapy

Conséquences cardiovasculaires de la mort cérébrale et prise en charge pour prélèvement d’organe(s)

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