title: Terlipressin in brain-death donors.
abstract: BACKGROUND
  Metabolic management of brain-death organ donors includes correction of the hormonal perturbations that occur after cerebral death and impair circulatory function. Vasopressin is a hormone secreted by the posterior pituitary gland, which contributes to maintain systemic blood pressure by regulating urine secretion and small arteriole tonus. During brain death, the pituitary gland is damaged and hormone secretion rapidly ceases. Low-dose vasopressin increases systemic blood pressure and decreases the need for catecholamines in brain-dead organ donors but it is not available in many countries. Terlipressin is a synthetic analog of vasopressin characterized by greater selectivity for the V1 receptor than vasopressin. To date, the efficacy of terlipressin as a pressor agent in humans has been reported in a few studies.
  
  
  METHODS
  Pharmacology and literature about the use of terlipressin in shock and in particularly in neurogenic shock following brain death is summarized and our personal experience is reported.
  
  
  CONCLUSIONS
  Terlipressin is helpful in controlling severe hypotension; its use allowed to reduce the infusion rate of norepinephrine about 50% in two of three brain-death organ donors, but there are not yet enough data to define its therapeutic range and incidence of collateral effects on the grafts.
authors.affiliation: Anestesiologia e Rianimazione, Università degli Studi di Salerno, Baronissi, Salerno, Italy. opiazza@unisa.it
authors.forename: Ornella
authors.initials: O
authors.lastname: Piazza
authors.forename: Giuliana
authors.initials: G
authors.lastname: Scarpati
authors.forename: Fabio
authors.initials: F
authors.lastname: Rispoli
authors.forename: Michele
authors.initials: M
authors.lastname: Iannuzzi
authors.forename: Rosalba
authors.initials: R
authors.lastname: Tufano
authors.forename: Edoardo
authors.initials: E
authors.lastname: De Robertis
mesh_terms: D001926:Brain Death; D006801:Humans; D007022:Hypotension / Q000188:drug therapy*; D008236:Lypressin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016377:Organ Transplantation; D000077585:Terlipressin; D014019:Tissue Donors; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
chemical_list: D014662:Vasoconstrictor Agents; D008236:Lypressin; D000077585:Terlipressin