title: The effect of arginine vasopressin on organ donor procurement and lung function.
abstract: BACKGROUND
  Hormone replacement therapy (HRT) is becoming more common when managing brain-dead donors. Arginine vasopressin (AVP) is associated with benefits but is not consistently used. We hypothesize that AVP is associated with the maintenance of lung function and successful recovery in donors and enhanced lung graft performance in recipients.
  
  
  METHODS
  The Organ Procurement and Transplantation Network database was used. Study donors were those treated with HRT and procured from January 1, 2009 to June 30, 2011. AVP (+) and AVP (-) donors were compared. Donor lung function, the rate of successful lung procurement, and the incidence of graft failure in recipients were studied.
  
  
  RESULTS
  There were 12,322 donors included, of which 7686 received AVP (62.4%). Cerebrovascular accident (4722 [38.3%]) was the most common cause of donor death. There was a significant increase in high yield (≥4 organs) (51.0% versus 39.3%, <0.001), mean number of organs (3.75 versus 3.33, <0.001), and rate of successful lung recovery (26.3% versus 20.5%, <0.001) with AVP. Lung function was preserved to a greater degree in donors receiving AVP. Adjusting the significant factors, AVP was independently associated with lung procurement (1.220 [1.114-1.336], <0.001). The incidence of early graft failure was not changed.
  
  
  CONCLUSIONS
  AVP with HRT is associated with the maintenance of lung function and a significant increase in successful organ recovery in donors without untoward effects in the recipient. AVP should be universally adopted as a component of HRT in the management of donors with neurologic death.
authors.affiliation: Department of Surgery, Division of Trauma/Acute Care Surgery and Surgical Critical Care, Harbor-UCLA Medical Center, Torrance, California. Electronic address: devon.callahan.md@gmail.com.
authors.forename: Devon S
authors.initials: DS
authors.lastname: Callahan
authors.forename: Angela
authors.initials: A
authors.lastname: Neville
authors.forename: Scott
authors.initials: S
authors.lastname: Bricker
authors.forename: Dennis
authors.initials: D
authors.lastname: Kim
authors.forename: Brant
authors.initials: B
authors.lastname: Putnam
authors.forename: Frederic
authors.initials: F
authors.lastname: Bongard
authors.forename: David S
authors.initials: DS
authors.lastname: Plurad
mesh_terms: D000328:Adult; D001127:Arginine Vasopressin / Q000494:pharmacology*; D005260:Female; D020249:Hormone Replacement Therapy; D006801:Humans; D008168:Lung / Q000187:drug effects* / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009927:Tissue and Organ Procurement
chemical_list: D001127:Arginine Vasopressin
keywords: Arginine vasopressin; Hormone replacement therapy; Outcomes; Thyroxine; Transplantation