Karayalçin K, Umaña J P, Harrison J D, Buckels J A, McMaster P, Mayer A D
Liver and Hepatobiliary Unit, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom.
Transplantation. 1994 Mar 15;57(5):669-72. doi: 10.1097/00007890-199403150-00007.
Brainstem death is associated with endocrine and metabolic alterations that can result in donor hemodynamic instability. It has been suggested that these changes can be reversed through hormonal manipulation of the donor. We measured thyroid hormone levels (free triiodothyronine [fT3], free tetraiodothyronine [fT4], reverse triiodothyronine) and thyroid-stimulating hormone (TSH) in 50 consecutive adult brain dead multiorgan donors. Recipient graft function was assessed using peak and day 5 aspartate aminotransferase, peak serum bilirubin, and minimum prothrombin time during the first week after OLT. Free T3 was low in 32/50 donors and was associated with a low fT4 in 24 cases. TSH was normal in 35 donors and we found no correlation between TSH levels and fT3 or fT4. Reverse triiodothyronine was normal or high in 96% of donors. Patient and graft survival were 96% for both the low and high fT3 groups. These data suggest that euthyroid sick syndrome is the most likely cause for the endocrine and metabolic alterations seen in brainstem-dead donors. This does not appear to influence liver recipient or graft survival.
脑干死亡与内分泌和代谢改变有关，这些改变可导致供体血流动力学不稳定。有人提出，通过对供体进行激素调控可以逆转这些变化。我们对50例连续的成年脑死亡多器官供体测量了甲状腺激素水平（游离三碘甲状腺原氨酸[fT3]、游离甲状腺素[fT4]、反三碘甲状腺原氨酸）和促甲状腺激素（TSH）。在肝移植术后第一周，使用峰值和第5天的天冬氨酸转氨酶、峰值血清胆红素和最短凝血酶原时间评估受者移植物功能。50例供体中有32例fT3水平低，其中24例同时伴有fT4水平低。35例供体TSH正常，我们发现TSH水平与fT3或fT4之间无相关性。96%的供体反三碘甲状腺原氨酸正常或升高。fT3水平低和高的两组患者及移植物存活率均为96%。这些数据表明，正常甲状腺病态综合征最有可能是脑干死亡供体出现内分泌和代谢改变的原因。这似乎并不影响肝移植受者或移植物的存活。
