[Functional and morphological changes of the liver after brain death maintained with the combined administration of vasopressin and catecholamine].

We investigated the functional and morphological changes of the liver after brain death for long period maintained with the combined administration of arginine vasopressin (ADH) and catecholamine. Twenty five brain-dead patients suffered from severe closed head injury were studied. The average age was 38.2 y.o. Systemic circulation was maintained normal for at least 6 days with ADH and catecholamine. ADH was infused constantly with an average dosage of 0.3 mU/kg/min. Simultaneous infusion of catecholamine was adjusted to maintain the mean arterial pressure above 80 mmHg. The morphological changes were not remarkable in the liver cells throughout the study. Levels of activated partial thromboplastin time (APTT) except in 5 patients remained within normal range for two weeks. According to this data, it can be considered that there is no marked lowering in the activity of protein synthesis of the liver. The progressive increase of serum alkaline phosphatase, LAP, gamma-GTP, and total bilirubin were observed as the characteristic changes of the liver after brain death. Serum levels of total bilirubin were markedly elevated especially in the patients who received massive transfusion. Histologically, cell infiltration into the Glisson's sheath became remarkable in all cases as day proceeded. These findings suggest the dysfunction of bile excretion might occur due to the denervation from the brain.