Effect of nutritional state of brain-dead organ donor on transplantation.
OBJECTIVE
We describe the effect of the metabolic and nutritional modifications caused by severe illness or injury in brain-dead organ donors on transplant organ function. Malnutrition is frequently found in brain-dead organ donors and nutrients may interfere with different organ functions.


METHODS
Literature was obtained from MEDLINE using the key words organ donation, brain death, transplantation, nutrition, fish oil, amino acids.


RESULTS
In the liver, infusion of large quantities of dextrose can restore glycogen reserves but may induce hyperglycemia and a hyperosmolar hepatic state. Feeding improves protein synthesis in hepatocytes, and fat (fish oil) administration in particular increases the hepatic energy and adenosine triphosphate content. Amino acids have a significant effect on regenerating hepatic tissue when given with fat and glucose. In the heart, free fatty acids administered during reperfusion improve cardiac functional recovery, and administration of propofol, a general anesthetic agent enriched with fatty acids, have protective effects on ischemia-and-reperfusion injury. Glutamine also can induce graft protection during ischemia-and-reperfusion injury. Renal function is improved by fish oil supplementation. In addition, effective renal plasma flow, glomerular filtration rate, and renal blood flow are increased, apparently by a reduction in thromboxane B2 production. Glycine or alanine can protect renal tubules from stress injury.


CONCLUSIONS
Nutrition plays an important role in the modulation of organ function after transplantation.
Singer
P
P
Department of General Intensive Care, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel. pierres@post.tau.ac.il
Cohen
J
J
Cynober
L
L
D000596:Amino Acids / Q000008:administration & dosage / Q000627:therapeutic use; D001926:Brain Death / Q000503:physiopathology*; D005395:Fish Oils / Q000008:administration & dosage / Q000627:therapeutic use; D005973:Glutamine / Q000008:administration & dosage / Q000627:therapeutic use; D006321:Heart / Q000502:physiology; D006801:Humans; D007668:Kidney / Q000502:physiology; D008099:Liver / Q000502:physiology; D016239:MEDLINE; D009748:Nutrition Disorders / Q000150:complications / Q000503:physiopathology* / Q000517:prevention & control; D009752:Nutritional Status; D016377:Organ Transplantation / Q000592:standards*; D015427:Reperfusion Injury / Q000628:therapy; D014019:Tissue Donors
D000596:Amino Acids; D005395:Fish Oils; D005973:Glutamine