A Novel Therapeutic Target To Improve Tissue Oxygenation And Increase The Number Of Viable Organs/vascular Composite For Transplant: Prospective Study On Brain Dead Donors
Mohamed Awad, MD, Ryan Nazemian, MD, Anand Kumar, MD, James Reynolds, PhD.
Case Western Reserve University, Cleveland, OH, USA.
Background: S-nitrosothiols (SNOs) are chemicals in the body that regulate a wide range of activities including blood flow, oxygen delivery, responses to disease or pollution, muscle performance, and metabolism. Our laboratory has demonstrated that brain death is associated with a decrease in SNO leading to a decrease in tissue micro perfusion. We hypothesized that SNO levels directly correlate with donor tissue/organ viability.
Methods: In a prospective cohort study of brain dead donors (n=63), serial measurements of S-nitrosohemoglobin (SNO-Hb) were collected and tissue oxygenation were monitored by tissue oxygen monitor (TStat). SNO levels were then correlated to microcirculation, organs failure rate, and lactate levels. The data was analyzed using R software.
Results: SNOHb levels decrease immediately after brain death. Increasing SNO-HB levels inversely correlated with lactate levels (p<00.1) (R=0.61). Increasing SNO-HB levels directly correlated with increasing tissue oxygenation (p<00.1). Regression analysis identified SNO-Hb as a strong primary predictor variable of percentage of organs recovered and as a direct predictor of quality of donor tissue (P=0.015) (R=0.4).
Conclusion: Our study demonstrated SNO-HB levels after brain death directly correlates with tissue perfusion and ultimately organ viability. Therapies to increase SNO-HB after brain death in the donor is a possible therapeutic target to improve microcirculation and the number of organs/VCA available for transplant.
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