Heart transplantation from brain dead donor in pigs - Effect of vasopressin and triiodothyronine on brain dead donor management

Brain dead donor management using vasoprressin and triiodothyronine as ''pretreatment'' for the candidate of heart transplantation is studied experimentally in pigs. Brain death was produced by ligation of the brachiocephalic artery and the left subclavian artery in 19 pigs, weighing of 20 similar to 25 kg. Seven pigs (group A) received continuous intravenous infusion of extracellular solution. Six pigs (group B) received vasopressin (0.1 U/kg/h) intravenously. Six pigs (group C) received vasopressin and Triiodothyronine(2 mu g/h). All animals were managed on the condition that had mean aortic pressure above 60 mmHg, and central venous pressure ranging from 3 to 8 cmH(2)O with dopamine dose of less than 5 mu g/kg/min. The cardiac graft was harvested under abdominal cavity cooling after brain dead donor management for 6 hours. The graft was then preserved in modified Euro-Collins solution for 3 hours. They were transplanted orthotopically. After induction of brain death, systemic vascular resistance and serum osmolality in groups B and C (vasopressin groups) were higher than those in group A. The higher aortic pressure, the lower myocardial water content, and less dose of dopamine were seen in groups B and C compared with those in group ii. Furthermore supplementation of triiodothyronine decreased dopamine dose requirement. Lactate/pyruvate ratio and myocardial oxygen consumption in group C was different from those values of group B. Acceptable hemodynamics after heart transplantation was confirmed in 2 of 7 in group A, 4 of 6 in group B, and 5 of 6 in group C. In conclusion, vasopressin was an effective agent for not only preventing diabetes inspidus, but also maintaining satisfactory hemodynamics during brain dead period. Administration of triiodothyronine improved aerobic metabolism during brain dead period. They provide an acceptable brain dead condition and suitable graft for heart transplantation.