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Gallegos EM, Reed T, Deville P, Platt B, Leonardi C, Bellfi L, Dufrene J, Chaudhary S, Hunt J, Stuke L, Greiffenstein P, Schoen J, Marr A, Paramesh A, Smith AA. Does the use of double hormone replacement therapy for trauma patient organ donors improve organ recovery for transplant. World J Transplant 2024; 14:89825. [DOI: 10.5500/wjt.v14.i2.89825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/16/2024] [Accepted: 04/16/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND With an ongoing demand for transplantable organs, optimization of donor management protocols, specifically in trauma populations, is important for obtaining a high yield of viable organs per patient. Endocrine management of brain-dead potential organ donors (BPODs) is controversial, leading to heterogeneous clinical management approaches. Previous studies have shown that when levothyroxine was combined with other treatments, including steroids, vasopressin, and insulin, BPODs had better organ recovery and survival outcomes were increased for transplant recipients.
AIM To determine if levothyroxine use in combination with steroids in BPODs increased the number of organs donated in trauma patients.
METHODS A retrospective review of adult BPODs from a single level 1 trauma center over ten years was performed. Exclusion criteria included patients who were not solid organ donors, patients who were not declared brain dead (donation after circulatory death), and patients who did not receive steroids in their hospital course. Levothyroxine and steroid administration, the number of organs donated, the types of organs donated, and demographic information were recorded. Univariate analyses were performed with P < 0.05 considered to be statistically significant.
RESULTS A total of 88 patients met inclusion criteria, 69 (78%) of whom received levothyroxine and steroids (ST/LT group) vs 19 (22%) receiving steroids without levothyroxine (ST group). No differences were observed between the groups for gender, race, pertinent injury factors, age, or other hormone therapies used (P > 0.05). In the ST/LT group, 68.1% (n = 47) donated a high yield (3-5) of organ types per donor compared to 42.1% (n = 8) in the ST group (P = 0.038). There was no difference in the total number of organ types donated between the groups (P = 0.068).
CONCLUSION This study suggests that combining levothyroxine and steroid administration increases high-yield organ donation per donor in BPODs in the trauma patient population. Limitations to this study include the retrospective design and the relatively small number of organ donors who met inclusion criteria. This study is unique in that it mitigates steroid administration as a confounding variable and focuses specifically on the adjunctive use of levothyroxine.
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Affiliation(s)
- Eden M Gallegos
- Department of Physiology, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA 70124, United States
| | - Tanner Reed
- Department of Medicine, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA 70112, United States
| | - Paige Deville
- Department of Surgery, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA 70112, United States
| | - Blake Platt
- Department of Trauma Surgery, Tacoma General Hospital, Tacoma 98405, United States
| | - Claudia Leonardi
- Department of Public Health, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA 70112, United States
| | - Lillian Bellfi
- Department of Surgery, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA 70112, United States
| | - Jessica Dufrene
- Department of Donation Services, Louisiana Organ Procurement Agency, Covington, LA 70433, United States
| | - Saad Chaudhary
- Department of Medicine, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA 70112, United States
| | - John Hunt
- Department of Surgery, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA 70112, United States
| | - Lance Stuke
- Department of Surgery, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA 70112, United States
| | - Patrick Greiffenstein
- Department of Surgery, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA 70112, United States
| | - Jonathan Schoen
- Department of Surgery, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA 70112, United States
| | - Alan Marr
- Department of Surgery, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA 70112, United States
| | - Anil Paramesh
- Department of Surgery, Tulane Transplant Institute, Tulane University School of Medicine, New Orleans, LA 70112, United States
| | - Alison A Smith
- Department of Surgery, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA 70112, United States
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Jan MY, Moe SM, Adebiyi O, Chen J, Powelson J, Burney HN, Yaqub MS, Mishler DP, Moorthi RN, Taber TE, Anderson MD, Li Y, Li X, Fridell JA, Goggins WC, Sharfuddin AA. Vasopressin for Post-kidney Transplant Hypotension. Kidney Int Rep 2022; 7:1364-1376. [PMID: 35694563 PMCID: PMC9174042 DOI: 10.1016/j.ekir.2022.03.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 03/24/2022] [Accepted: 03/29/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction Hypotension after deceased donor kidney transplant (DDKT) is a risk factor for delayed graft function (DGF) and poor graft survival (GS). We hypothesize that vasopressin use in hypotensive DDKT recipients (DDKTRs) to increase blood pressure (BP) reduces DGF rates and is safe without increasing mortality. Methods Group with vasopressin "study group" (n = 45) was defined as DDKTRs between 2012 and 2017 who required vasopressin for hypotension systolic BP (SBP) <120 mm Hg or diastolic BP (DBP) <60 mm Hg. DDKTRs with no-vasopressin "comparison group" (n = 90) were propensity score-matched DDKTRs between 2012 and 2017 without vasopressin use. Primary outcomes were GS, creatinine and allograft biopsy rate at 1 year, DGF rate, and death during transplant hospitalization. Results Vasopressin group had lower mean maximum and minimum SBP and DBP in the operating room (OR). Median vasopressin start time post-DDKT was 2 hours (interquartile range [IQR] 1-6), and duration of use was 42 hours (IQR 24-63). DGF, creatinine at 1 year, and allograft biopsy rates were comparable. No deaths occurred during transplant hospitalization. Multivariable analysis did not find an effect of vasopressin use on GS. Conclusion Treatment of hypotensive DDKTRs with vasopressin is safe and facilitated similar graft function and survival with that of nonhypotensive patients. In the absence of a randomized control trial, our study supports the safety of vasopressin therapy to prevent the adverse effects of hypotension.
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Affiliation(s)
- Muhammad Y. Jan
- Division of Nephrology and Hypertension, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Sharon M. Moe
- Division of Nephrology and Hypertension, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Indiana Clinical and Translational Sciences Institute, Indianapolis, Indiana, USA
| | - Oluwafisayo Adebiyi
- Division of Nephrology and Hypertension, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jeannie Chen
- Department of Pharmacy, Indiana University Health, Indianapolis, Indiana, USA
| | - John Powelson
- Division Transplant Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Heather N. Burney
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Muhammad S. Yaqub
- Division of Nephrology and Hypertension, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Dennis P. Mishler
- Division of Nephrology and Hypertension, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ranjani N. Moorthi
- Division of Nephrology and Hypertension, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Tim E. Taber
- Division of Nephrology and Hypertension, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Melissa D. Anderson
- Division of Nephrology and Hypertension, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Yang Li
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Xiaochun Li
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jonathan A. Fridell
- Division Transplant Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - William C. Goggins
- Division Transplant Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Asif A. Sharfuddin
- Division of Nephrology and Hypertension, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Henry NR, Gardner DD, Rodrigues N. Development of a Pulmonary Workshop for Organ Recovery Coordinators' Continuing Medical Education. Prog Transplant 2020; 30:372-375. [PMID: 32930043 DOI: 10.1177/1526924820958113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Organ recovery coordinators (ORCs) have varied professional education backgrounds; however, based on their specialized education, their training may not have included in-depth mechanical ventilation and pulmonary management. An 8-hour pulmonary workshop was developed in collaboration between an organ procurement organization and a university-based respiratory care department. The workshop focused on pulmonary management and hands-on laboratory exercises using mechanical ventilators. A program assessment questionnaire was completed by participants following the workshop, which requested their self-reported comfort/familiarity with pulmonary management skills before and after the workshop on a 5-point Likert scale. Following the pulmonary workshop, the mean ORC comfort/familiarity for all pulmonary management skills increased significantly (P < .01). This program suggests ORCs can develop a greater awareness and comfort with pulmonary management by participating in a continuing education pulmonary workshop. Continuing education initiatives focused on pulmonary management of donor patients using hands-on competencies should be part of the ORCs practice improvement efforts.
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Affiliation(s)
- Nicholas R Henry
- Department of Respiratory Care, 7174Texas State University, Round Rock, TX, USA.,Texas Organ Sharing Alliance, San Antonio, TX, USA
| | - Donna D Gardner
- Department of Respiratory Care, 7174Texas State University, Round Rock, TX, USA
| | - Nathan Rodrigues
- Department of Respiratory Care, 7174Texas State University, Round Rock, TX, USA
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Li L, Gao Y, Lu C, Guo M. Characterization of the intestinal graft in a swine hypotensive after brain death model. Acta Cir Bras 2020; 34:e201901107. [PMID: 31939503 PMCID: PMC6956644 DOI: 10.1590/s0102-865020190110000007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 10/23/2019] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To establish a hypotensive brain death pig model and observe the effects of hypotension on small bowel donors. METHODS The hypotensive brain death model was produced using the modified intracranial water sac inflation method in ten domestic crossbred pigs. Effects of hypotensive brain death on small bowel tissue morphology were evaluated through changes in intestinal tissue pathology, tight junction protein of the intestinal mucosa and plasma intestinal fatty acid-binding protein (i-FABP) levels. The pathophysiological mechanism was examined based on changes in superior mesenteric artery (SMA) blood flow and systemic hemodynamics. RESULTS After model establishment, SMA blood flow, and the mean arterial pressure (MAP) significantly decreased, while heart rate increased rapidly and fluctuated significantly. Small bowel tissue morphology and levels of tight junction protein of the intestinal mucosa showed that after model establishment, small bowel tissue injury was gradually aggravated over time (P<0.05). Plasma i-FABP levels significantly increased after brain death (P<0.05). CONCLUSIONS A hypotensive brain death pig model was successfully established using an improved intracranial water sac inflation method. This method offers a possibility of describing the injury mechanisms more clearly during and after brain death.
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Affiliation(s)
- Linlin Li
- MD, Department of Psychiatry, Linyi Municipal Mental Health Center, Linyi, 276005, China. Acquisition of data, manuscript writing
| | - Ying Gao
- MD, Department of General Surgery, Linyi People's Hospital, Xuzhou Medical University, Linyi, 276000, China. Statistics analysis
| | - Chunlei Lu
- MD, Department of General Surgery, Linyi People's Hospital, Xuzhou Medical University, Linyi, 276000, China. Analysis and interpretation of data
| | - Mingxiao Guo
- MD, Department of General Surgery, Linyi People's Hospital, Xuzhou Medical University, Linyi, 276000, China. Conception and design of the study
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Zirpe KG, Suryawanshi P, Gurav S, Deshmukh A, Pote P, Tungenwar A, Malhotra R. Increase in Cadaver Organ Donation Rate at a Tertiary Care Hospital: 23 Years of Experience. Indian J Crit Care Med 2020; 24:804-808. [PMID: 33132564 PMCID: PMC7584817 DOI: 10.5005/jp-journals-10071-23578] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background Transplantation of Human Organ Act was passed in India in 1994 to streamline organ donation and transplantation activities. It is time to retrospect ourselves and analyze the method to increase organ donation. Type of study Retrospective observational analysis. Objectives To evaluate the change in organ donation rate and reasons for changes in rates. Subjects Brainstem dead declared patients whose family consented for organ donations in the last 23 years (1997–2019) at Ruby Hall Clinic, Pune, India. Materials and methods Retrospectively demographic data of the brainstem dead declared donors, the primary diagnoses, comorbidities, and the complete data of their management till organ retrieval was assessed. Results One hundred cases in the age group 15–75 years (mean 41.6 ± 15.3 years) of brainstem death consented for organ donation were retrospectively studied. The period was divided into two groups, group I and group II included study duration from 1997 to 2013 and from 2013 to 2019 respectively. During the entire period, though the major cause of donor death remained road traffic accidents (RTA) in both the groups (84.21% till 2013 vs 48.15% after 2013), the proportion of donors declared brain dead due to RTA dipped significantly after 2013 (p = 0.004) and the non-RTA causes of brain dead contributed more than RTA causes (51.85% non-RTA vs 48.15% RTA). The major contributor among non-RTA causes was intracranial bleeds (5.26% before 2013 vs 33.33% after 2013, p = 0.014). Compared to the previous 17 years (from 1997) there were more than fourfold rise in the rate of transplantation in the last 6 years (2014–2019) at our institute. Kidneys were retrieved from 90% donors followed by cornea 84%, liver 65%, heart 22%, skin 7%, lungs 6%, and pancreas 5%. Conclusion We have observed that the cadaveric organ donation rate significantly improved after 2013. Reasons might be widening of the donor pool by the selection of more of non-RTA brain death donors over RTA, acceptability of elderly population donor (>60 years) by our transplant teams, early identification of potential organ donor, and better protocol-based management of the cadaver organ donor. How to cite this article Zirpe KG, Suryawanshi P, Gurav S, Deshmukh A, Pote P, Tungenwar A, et al. Increase in Cadaver Organ Donation Rate at a Tertiary Care Hospital: 23 Years of Experience. Indian J Crit Care Med 2020;24(9):804–808.
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Affiliation(s)
- Kapil G Zirpe
- Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | | | - Sushma Gurav
- Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Abhijeet Deshmukh
- Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Prajakta Pote
- Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Amit Tungenwar
- Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Ria Malhotra
- Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
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