title: Vasopressin deficiency and pressor hypersensitivity in hemodynamically unstable organ donors.
abstract: BACKGROUND
  Solid organ donors often develop hypotension due to vasodilation, and recently we observed that a variety of vasodilatory states are characterized by vasopressin deficiency and hypersensitivity. Thus, we investigated the prevalence of vasopressin deficiency in hypotensive solid organ donors without clinical evidence of diabetes insipidus; we also investigated the vasopressor effect of vasopressin replacement in hypotensive donors.
  
  
  RESULTS
  Fifty organ donors were evaluated for hemodynamic instability, (mean arterial pressure [MAP]</= 70 mm Hg despite the use of catecholamine vasopressors), and in those unstable donors who were not already receiving exogenous vasopressin, low-dose vasopressin was administered as a continuous infusion (0. 04 to 0.1 U/min). MAP, catecholamine requirements, serum vasopressin, and serum osmolality were obtained before and after vasopressin administration. Ten patients meeting the enrollment criteria received vasopressin and MAP increased from 72.2+/-3.5 to 89.8+/-4.2 mm Hg, (P<0.05), allowing for complete discontinuation of catecholamine pressors in 4 (40%) patients and a decrement in pressor dose in 4 (40%). Plasma vasopressin levels (2.9+/-0.8 pg/mL) were low for the degree of hypotension.
  
  
  CONCLUSIONS
  Hemodynamically unstable organ donors without clinically apparent diabetes insipidus display a defect in the baroreflex-mediated secretion of vasopressin. In these patients, low-dose vasopressin significantly increases blood pressure with a pressor response sufficient to reduce catecholamine administration.
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY, USA. jmc23@columbia.edu
authors.forename: J M
authors.initials: JM
authors.lastname: Chen
authors.forename: S
authors.initials: S
authors.lastname: Cullinane
authors.forename: T B
authors.initials: TB
authors.lastname: Spanier
authors.forename: J H
authors.initials: JH
authors.lastname: Artrip
authors.forename: R
authors.initials: R
authors.lastname: John
authors.forename: N M
authors.initials: NM
authors.lastname: Edwards
authors.forename: M C
authors.initials: MC
authors.lastname: Oz
authors.forename: D W
authors.initials: DW
authors.lastname: Landry
mesh_terms: D000293:Adolescent; D000328:Adult; D017704:Baroreflex; D001794:Blood Pressure / Q000187:drug effects; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009994:Osmolar Concentration; D014019:Tissue Donors; D014667:Vasopressins / Q000008:administration & dosage / Q000097:blood*
chemical_list: D014667:Vasopressins