Effects of Terlipressin on Management of Potential Organ Donors
Condition: Organ Donors
Study type: Observational

Summary: 
      During brain death, many significant systemic changes take place and among these, the most
      notable is hemodynamic instability.

      In the pathogenesis of brain death, after the hypertensive phase of the "catecholamine
      storm", arterial tonus and heart inotropism eventually deteriorate, leading to hypotension
      and hypoperfusion. Therefore, vasopressor agents are necessary in treatment of brain-dead
      organ donors. The most commonly used and recommended vasoactive drugs for this indication are
      dopamine, norepinephrine, and vasopressin.The Transplantation Committee of the American
      College of Cardiology recommends vasopressin as the primary vasoactive drug for treating
      hemodynamic instability and diabetes insipidus in brain-death heart donors.

      Terlipressin (TP) is a new type of synthetic long-acting vasopressin preparations, AVP
      long-acting derivatives, belongs to a kind of precursor drugs, itself is inactive, the body
      through the aminopeptidase, slow "release" of a reactive lysine vasopressin. On the one
      hand，terlipressin can splanchnic vascular smooth muscle contraction, reduces splanchnic blood
      flow (e.g., reduce blood flow to the mesenteric, spleen, uterus, etc), to ensure the flow of
      blood to the important viscera;On the other hand, it reduces the concentration of plasma
      renin, increases the perfusion of renal blood flow, and improves the glomerular filtration
      rate, thus improving renal function.From the pharmacological perspective, it is better than
      arginine vasopressin for the stability of hemodynamics and the perfusion of tissue.

      Whether or not it has therapeutic effect on the potential brain death donor with unstable
      hemodynamics is not studied in the literature at home and abroad.This paper discusses the
      application value of terlipressin in the management of potential brain death, and provides
      clinical evidence for the maintenance of brain death donor.
    

Detailed description: 
      Thermodilution cardiac output was measured in triplicate. Hemodynamic parameters were
      calculated according to standard formulas.Oxygen delivery index (IDO2) was calculated as
      arterial oxygen content multiplied by CI. Systemic vascular resistance index (SVRI) was
      calculated as the MAP minus right atrial pressure divided by CI and multiplied by 80.
      Pulmonary vascular resistance index (PVRI) was calculated as the mean pulmonary artery
      pressure (PAP) minus pulmonary artery occlusion pressure divided by CI. Left and right
      ventricular stroke work index (L and RVSWI) were calculated .The following laboratory
      parameters were collected: bilirubin, aspartate aminotransferase (AST), alanine
      aminotransferase (ALT),prothrombin time, and thrombocytes.
    

Intervention name(s): terlipressin
Intervention type(s): Drug
Intervention description(s): a continuous infusion of terlipressin (0.4 mg/kg/h) was initiated
Intervention MeSH terms: Terlipressin
Observational model: Other
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        18 patients were enrolled. All were potential organ donors.