Administration of desmopressin in brain-dead donors and renal function in kidney recipients.
BACKGROUND
Diabetes insipidus is common among brain-dead donors and may lead to decreased graft function. The use of desmopressin to limit the consequences of diabetes insipidus is controversial. We assessed the effects of desmopressin administered to brain-dead donors on early and long-term graft function in kidney recipients.


METHODS
In a randomised controlled study, 97 brain-dead donors received desmopressin as 1 microg bolus every 2 h when diuresis was more than 300 mL/h (desmopressin group n=49) or no desmopressin (control group n=48). In 175 kidney recipients (controls n=89, desmopressin group n=86) we measured serum concentrations of creatinine and haemodialysis requirements to assess early renal function in the first 15 days after transplantation. We assessed long-term results of transplantation (median time 45 months) for a homogeneous subgroup of 95 recipients (48 in the desmopressin group).


RESULTS
We found no significant differences between the two groups of brain-dead donors, except for final diuresis, which was lower in the desmopressin group than among controls. Haemodialysis requirement in controls and the desmopressin group (20 vs 23%, p=0.63) and serum creatinine concentrations (decrease from 903 micromol/L to 206 micromol/L vs 814 micromol/L to 193 micromol/L, p=0.14) did not differ significantly in the first 15 days after transplantation. Long-term graft survival was similar in the two groups (88 vs 87%).


CONCLUSIONS
Desmopressin can be given to brain-dead donors to limit the harmful effects of diabetes insipidus without any substantial effects to graft function in recipients.
Department of Anesthesiology and Critical Care, Groupe Hospitalier Pitié-Salpêtrière, Paris VI University, France. richard.guesde@psl.ap-hop-paris.fr
R
R
Guesde
B
B
Barrou
I
I
Leblanc
S
S
Ourahma
J P
JP
Goarin
P
P
Coriat
B
B
Riou
D000328:Adult; D001926:Brain Death / Q000503:physiopathology*; D003404:Creatinine / Q000097:blood; D003894:Deamino Arginine Vasopressin / Q000008:administration & dosage*; D003919:Diabetes Insipidus / Q000517:prevention & control*; D005260:Female; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D012076:Renal Agents / Q000008:administration & dosage*; D006435:Renal Dialysis; D013997:Time Factors; D014019:Tissue Donors; D016896:Treatment Outcome
D012076:Renal Agents; D003404:Creatinine; D003894:Deamino Arginine Vasopressin