DOI: https://doi.org/10.22263/2312-4156.2021.6.7
Lipnitski A.L.1,2, Marochkov А.V.1,2, Karpelev G.M.1,2, Lipnitskaya V.V.3
Cortisol level in potential organ donors
1Mogilev Regional Clinical Hospital, Mogilev, Republic of Belarus
2Vitebsk State Order of Peoples’ Friendship Medical University, Vitebsk, Republic of Belarus
3Mogilev City Emergency Hospital, Mogilev, Republic of Belarus
Vestnik VGMU. 2021;20(6):7-13.
Abstract.
Currently, the need for the administration of corticosteroids to restore the normal adrenal function in patients with brain death (BD) in order to condition the functional systems before organ harvesting remains unclear.
Objectives. To analyze the level of cortisol in potential donors with brain death before harvesting their organs and tissues for transplantation.
Material and methods. A prospective pilot study included 60 patients with brain death. The average age of a patient with brain death was 53.5 (48.5; 58.5) years, males – 32 (53.3%) years, females – 28 (46.7%) years. The causes of brain death were: intracerebral hemorrhage – in 30 (50%) patients, traumatic brain injury – in 10 (16.7%) patients, subarachnoid hemorrhage – in 7 (11.7%) patients, cerebral infarction – in 13 (21.6%) patients. The level of cortisol in the blood was determined by the method of radioimmune assay using a set of reagents UP «PP IBC NAS of Belarus» (Minsk, Republic of Belarus).
Results. The cortisol level in patients with BD was 422.8 (216.7; 687.1) nmol/L. The level of cortisol was lower than the reference values in 11 (18.3%) patients with BD, and higher – in 12 (20%) patients. There were no differences between the groups in terms of cortisol level in the following parameters: arterial blood pressure, heart rate, frequency of vasopressors use, dose of vasopressors, time from the patient’s admission to the moment of BD diagnosis, time of observation of a potential donor between two examinations of the council, the number of organs being harvested for transplantation.
Conclusions. In potential donors with brain death with low cortisol level, the indices of arterial blood pressure and the doses of injected vasopressors did not statistically significantly differ from those in donors with normal and elevated cortisol level.
Key words: cortisol, brain death, potential donor, organ donor, transplantation.
Information about the source of support in the form of grants, equipment, medicinal agents. The study was carried out within the framework of the grant of the President of the Republic of Belarus in healthcare «For the development and implementation into clinical practice of new methods of diagnosing and conditioning of the functional systems of a deceased donor in order to increase the efficiency of conditioning and subsequent transplantation of organs and tissues» (Order of the President of the Republic of Belarus dated 19 January, 2018, No. 32 rp).
References
1. Rummo OO, Dziadzko AM, Fedoruk AM, Shcherba AE, Minov AF. Organization of a liver transplant service in the Republic of Belarus. Transplantologiia. 2010;(1):68-72. (In Russ.)
2. Shchastnyi AT, Mikhnevich EV. Achievements and problems of transplantation at the present stage. Vestn VGMU. 2018;17(5):7-16. (In Russ.)
3. Lipnitckii AL, Marochkov AV, Savostenko IIa. Assessment of the functional systems of potential organ donors for transplantation, before ascertaining brain death. V: M-vo zdravookhraneniia Resp Belarus', Belorus assots khirurgov, Uchrezhdenie obrazovaniia «Grodnenskii gos med. un-t»; Kondratenko GG, red. Khirurgiia Belarusi na sovremennom etape: materialy KhVI s"ezda khirurgov Resp Belarus' i Resp nauch-prakt konf «Khirurgiia Belarusi na sovremennom etape» (Grodno, 1–2 noiab 2018 g.): v 2 ch. Grodno, RB; 2018. Р. 320-2. (In russ.)
4. Lipnitckii AL, Tochilo SA, Marochkov AV, Borisov OL, Antipenko AA. Application of reohepatography in a potential donor to assess the function of the hepatic graft. Vestn VGMU. 2020;19(4):53-61. (In russ.)
5. Vinogradov VL. Management of a Potential Brain Death Donor (Part 1). Transplantologiia. 2014;(3):23-31. (In Russ.)
6. Sergienko SK, Reznik EN, Pustovalov AA, Loginov IV. Principles of Intensive Care for a Brain Death Donor. Vestn Transplantologii Ikusstv Organov. 2010;12(4):72-9. (In russ.)
7. Dupuis S, Amiel J-A, Desgroseilliers M, Williamson DR, Thiboutot Z, Serri K, et al. Corticosteroids in the management of brain-dead potential organ donors: a systematic review. Br J Anaesth. 2014 Sep;113(3):346-59. doi: http://dx.doi.org/10.1093/bja/aeu154
8. Dimopoulou I, Tsagarakis S, Anthi A, Milou E, Ilias I, Stavrakaki K, et al. High prevalence of decreased cortisol reserve in brain-dead potential organ donors. Crit Care Med. 2003 Apr;31(4):1113-7. doi: http://dx.doi.org/10.1097/01.CCM.0000059644.54819.67
9. On approval of the Instruction on the procedure for establishing death and invalidating the resolution of the Ministry of Health of the Republic of Belarus dated July 2, 2002 No. 47: postanovlenie M-va zdravookhraneniia Resp Belarus', 20 dek 2008 g, № 228. V: OOO «Professional'nye pravovye sistemy». Biznes-info. Analiticheskaia pravovaia sistema [Elektronnyi resurs]. Minsk, RB; 2021. (In russ.)
10. Stulina ID, red. Diagnosing brain death. Moscow, RF: GEOTAR-Media; 2010. 112 р. (In Russ.)
11. Nicolas-Robin A, Barouk JD, Darnal E, Riou B, Langeron O. Free cortisol and accuracy of total cortisol measurements in the diagnosis of adrenal insufficiency in brain-dead patients. Anesthesiology. 2011 Sep;115(3):568-74. doi: http://dx.doi.org/10.1097/ALN.0b013e31822a702f
12. Mariot J, Jacob F, Voltz C, Perrier JF, Strub P. Value of hormonal treatment with triiodothyronine and cortisone in brain dead patients. Ann Fr Anesth Reanim. 1991;10(4):321-8. doi: http://dx.doi.org/10.1016/s0750-7658(05)80806-8
13. Venkateswaran RV, Dronavalli V, Lambert PA, Steeds RP, Wilson IC, Thompson RD, et al. The proinflammatory environment in potential heart and lung donors: prevalence and impact of donor management and hormonal therapy. Transplantation. 2009 Aug;88(4):582-8. doi: http://dx.doi.org/10.1097/TP.0b013e3181b11e5d
14. Boonen E, Vervenne H, Meersseman P, Andrew R, Mortier L, Declercq PE, et al. Reduced cortisol metabolism during critical illness. N Engl J Med. 2013 Apr;368(16):1477-88. doi: http://dx.doi.org/10.1056/NEJMoa1214969
Information about authors:
Lipnitski A.L. – Candidate of Medical Sciences, anesthesiologist-resuscitator, head of the department for taking organs and tissues for transplantation, Mogilev Regional Clinical Hospital; lecturer of the affiliated branch of the Chairs of Anesthesiology and Resuscitation with the course of the Faculty for Advanced Training & Retraining and Hospital Surgery of the Faculty for Advanced Training & Retraining, Vitebsk State Order of Peoples’ Friendship Medical University,
ORCID: https://orcid.org/0000-0002-2556-4801
Marochkov A.V. – Doctor of Medical Sciences, professor, anesthesiologist-resuscitator of the anesthesiology and resuscitation department, Mogilev Regional Clinical Hospital; professor of the affiliated branch of the Chairs of Anesthesiology and Resuscitation with the course of the Faculty for Advanced Training & Retraining and Hospital Surgery of the Faculty for Advanced Training & Retraining, Vitebsk State Order of Peoples’ Friendship Medical University,
ORCID: https://orcid.org/0000-0001-5092-8315
Karpelev G.M. – Candidate of Medical Sciences, physician of radionuclide diagnostics, head of the isotope laboratory, Mogilev Regional Clinical Hospital; lecturer of the affiliated branch of the Chairs of Anesthesiology and Resuscitation with the course of the Faculty for Advanced Training & Retraining and Hospital Surgery of the Faculty for Advanced Training & Retraining, Vitebsk State Order of Peoples’ Friendship Medical University,
ORCID: https://orcid.org/0000-0001-7108-6743
Lipnitskaya V.V. – anesthesiologist-resuscitator of the anesthesiology and resuscitation department, Mogilev City Emergency Hospital,
ORCID: https://orcid.org/0000-0003-2412-6655
Correspondence address: Republic of Belarus, 212016, Mogilev, 12 Belynitsky-Birula str., Mogilev Regional Clinical Hospital, the department for taking organs and tissues for transplantation. E-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра. – Artur L. Lipnitski.
