Use of Norepinephrine in Pancreas Donors and Its Influence on Patient and Graft Survival

Introduction Brain death originates a vasomotor center dysfunction, a decrease in catecholamine release and finally vasodilatation secondary to the decrease of the peripheral vascular resistence. To this we should add the relative dehydration resulting from a mixture of previous water restriction and polyuria secondary to vasopresin deficiency that will originate hypovolemia and hypotension in a potential donor. Because the most important factor in the viability and graft function is adequate donor perfusion, it has been postulated that donor catecholamines administration might have a beneficial effect on kidney function, while its effect on other organs is unknown. The aim of this study was to determine if norepinephrine in the donor is associated with recipient and pancreatic graft survival. Methods We performed a retrospective and comparative study, between the patients transplantated with a pancreatic graft proceeding from a donor where norepinephrine was used (Group A) and patients transplantated with a graft where norepinephrine was not used (Group B). Results 165 patients that underwent simultaneous pancreatic-kidney transplantation were included. The mean recipient age was 38.9 years, while the donor age was 28.6 years. 58.4% of the donors and 66.5% of the recipients were men. Grafts from group A presented an adequate function in 69% of the cases (p=0.03). The patient actuarial survival at 1.3 and 5 years in group A was: 94.9%, 93.3% and 92.5% respectively and in group B: 96.6%, 89.5% and 89.5% (p=0.6). The graft actuarial survival in group A was 82.8%, 78.9%, 72.9%, as compared to 75,9%, 68,4% and 63,8% respectively in group B (p=0.05). Conclusion Pancreatic grafts proceeding from donors who received norepinephrine present a significantly increased graft survival compared to grafts proceeding from donors without norepinephrine. No differences were seen in the patient survival between both groups.